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General NPI Number Information
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NPI Number | 1588140131
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Entity Type | Organization
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Legal Business Name | ALLIANCE PHARMACY LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 9601 N BEACH ST STE 105
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City | FORT WORTH
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State | TX
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Zip | 76244-6432
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Country | US
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Telephone | 409-293-9399
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Fax |
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Provider Business Mailing Address
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Address Line | 9601 N BEACH ST STE 105
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City | FORT WORTH
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State | TX
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Zip | 76244-6432
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Country | US
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Telephone | 409-293-9399
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JESSEY NGUYEN
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Credential |
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Telephone | 817-952-1999
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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 | 32160
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License Number State | TX
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