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General NPI Number Information
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NPI Number | 1407304132
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Entity Type | Organization
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Legal Business Name | ALTIMATE CARE PHARMACY LLC
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 2813 N COMMERCE ST STE 115
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City | FORT WORTH
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State | TX
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Zip | 76106-7245
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Country | US
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Telephone | 682-385-9100
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Fax | 682-385-9102
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Provider Business Mailing Address
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Address Line | 2813 N COMMERCE ST STE 115
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City | FORT WORTH
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State | TX
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Zip | 76106-7245
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Country | US
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Telephone | 682-385-9100
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Fax | 682-385-9102
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Authorized Official
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Title or Position | OWNER
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Name | KYLE RICHARDSON
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Credential |
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Telephone | 940-390-7103
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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 |
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License Number State |
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