Healthcare Provider Details

I. General information

NPI: 1144784836
Provider Name (Legal Business Name): RODRIGUE TCHAKOUNTE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 WESTERN CENTER BLVD
HALTOM CITY TX
76137-2635
US

IV. Provider business mailing address

14500 JFK BLVD
FORT WORTH TX
76155-1110
US

V. Phone/Fax

Practice location:
  • Phone: 817-514-8063
  • Fax:
Mailing address:
  • Phone: 301-237-4384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61678
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: