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General NPI Number Information
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NPI Number | 1518397025
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Entity Type | Organization
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Legal Business Name | FW MEDICAL SUPPLIES, LLC D/B/A DANDY DRUG
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 5450 E FM 1187
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City | BURLESON
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State | TX
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Zip | 76028-3060
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Country | US
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Telephone | 817-483-3784
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Fax | 817-483-0568
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Provider Business Mailing Address
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Address Line | 5450 E FM 1187
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City | BURLESON
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State | TX
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Zip | 76028-3060
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Country | US
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Telephone | 817-483-3784
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Fax | 817-483-0568
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Authorized Official
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Title or Position | PIC/OWNER
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Name | STEVEN KUPER
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Credential |
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Telephone | 817-456-4348
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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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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28891
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License Number State | TX
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