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General NPI Number Information
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NPI Number | 1174862718
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Entity Type | Organization
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Legal Business Name | THE MAIN PHARMACY
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 1226 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4803
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Country | US
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Telephone | 817-938-4352
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11671
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City | FORT WORTH
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State | TX
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Zip | 76110-0671
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Country | US
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Telephone | 817-938-4352
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | MR. NEMUEL PETTIE
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Credential |
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Telephone | 972-489-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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