Healthcare Provider Details

I. General information

NPI: 1790791531
Provider Name (Legal Business Name): A-1 DRUG MART INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 RIVER OAKS BLVD
FT WORTH TX
76114-3097
US

IV. Provider business mailing address

4821 RIVER OAKS BLVD
FT WORTH TX
76114-3097
US

V. Phone/Fax

Practice location:
  • Phone: 817-626-3744
  • Fax: 817-625-8103
Mailing address:
  • Phone: 817-626-3744
  • Fax: 817-625-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1863
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number6331
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY005812
License Number StateAZ

VIII. Authorized Official

Name: SANDER SPENCE
Title or Position: PRESIDENT
Credential: PHARMACY
Phone: 817-676-3744