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General NPI Number Information
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NPI Number | 1306341128
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Entity Type | Organization
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Legal Business Name | MATLOCK VILLAGE FAMILY PHARMACY, PLLC
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Dates
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Enumeration Date | 03/25/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6201 MATLOCK RD STE 125
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City | ARLINGTON
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State | TX
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Zip | 76002-2763
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Country | US
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Telephone | 817-538-5534
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Fax | 817-538-5441
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Provider Business Mailing Address
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Address Line | 6201 MATLOCK RD STE 125
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City | ARLINGTON
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State | TX
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Zip | 76002-2763
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Country | US
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Telephone | 817-538-5534
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Fax | 817-538-5441
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Authorized Official
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Title or Position | PIC
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Name | SHIRLEY THOMAS
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Credential | R.PH.
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Telephone | 214-893-0885
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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 | 31926
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License Number State | TX
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