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General NPI Number Information
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NPI Number | 1245579143
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Entity Type | Organization
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Legal Business Name | I.D. DOCTORS PHARMACY
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 2636 TIBBETS DR
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City | BEDFORD
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State | TX
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Zip | 76022-6919
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Country | US
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Telephone | 817-858-0065
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Fax |
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Provider Business Mailing Address
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Address Line | 2636 TIBBETS DR
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City | BEDFORD
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State | TX
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Zip | 76022-6919
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Country | US
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Telephone | 972-484-7700
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | HEEWON SUH
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Credential |
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Telephone | 972-484-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 21765
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License Number State | TX
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