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General NPI Number Information
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NPI Number | 1790791531
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Entity Type | Organization
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Legal Business Name | A-1 DRUG MART INC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 4821 RIVER OAKS BLVD
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City | FT WORTH
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State | TX
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Zip | 76114-3097
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Country | US
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Telephone | 817-626-3744
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Fax | 817-625-8103
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Provider Business Mailing Address
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Address Line | 4821 RIVER OAKS BLVD
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City | FT WORTH
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State | TX
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Zip | 76114-3097
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Country | US
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Telephone | 817-626-3744
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Fax | 817-625-8103
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDER SPENCE
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Credential | PHARMACY
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Telephone | 817-676-3744
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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 | 1863
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License Number State | TX
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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 | 6331
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License Number State | CO
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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 | Y005812
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License Number State | AZ
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