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General NPI Number Information
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NPI Number | 1205904299
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Entity Type | Organization
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Legal Business Name | MEADOWBROOK PHARMACY, INC.
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6637 MEADOWBROOK DR
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City | FORT WORTH
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State | TX
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Zip | 76112-5240
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Country | US
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Telephone | 817-451-5611
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Fax | 817-457-8804
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Provider Business Mailing Address
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Address Line | 6637 MEADOWBROOK DR
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City | FORT WORTH
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State | TX
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Zip | 76112-5240
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Country | US
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Telephone | 817-451-5611
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Fax | 817-457-8804
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LAWRENCE GEORGE LUDINGTON
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Credential | RPH
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Telephone | 817-451-5613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 12121
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License Number State | TX
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