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General NPI Number Information
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NPI Number | 1720538622
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Entity Type | Organization
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Legal Business Name | JOHN PETER SMITH HEALTH NETWORK
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-702-1346
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-702-1346
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. NICOLE OLUCHI ANIDIOBI
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Credential | PHARM.D.
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Telephone | 817-702-1346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 57163
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License Number State | TX
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