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General NPI Number Information
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NPI Number | 1649507708
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Entity Type | Individual
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Provider Name | VICKI VAN MAI PHARMD.
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Gender | Female
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 3809 E. BELKNAP ST.
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City | FORT WORTH
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State | TX
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Zip | 76111
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Country | US
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Telephone | 817-834-7283
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Fax |
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Provider Business Mailing Address
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Address Line | 705 WILLINGTON DR.
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City | ARLINGTON
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State | TX
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Zip | 76018
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Country | US
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Telephone | 817-468-1551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 183500000X45901
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License Number State | TX
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