Healthcare Provider Details

I. General information

NPI: 1043104458
Provider Name (Legal Business Name): REGENCY IHS PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 GRAVEL DR
FORT WORTH TX
76118-6950
US

IV. Provider business mailing address

2310 GRAVEL DR
FORT WORTH TX
76118-6950
US

V. Phone/Fax

Practice location:
  • Phone: 817-562-0268
  • Fax:
Mailing address:
  • Phone: 817-562-0268
  • Fax: 817-546-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KERI LUKERT KRUPP
Title or Position: DIRECTOR
Credential: PHARM. D.
Phone: 512-248-5130