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General NPI Number Information
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NPI Number | 1881193282
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Entity Type | Organization
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Legal Business Name | FOTOK ENTERPRISES
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 701 S STEMMONS FWY STE 230
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City | LEWISVILLE
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State | TX
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Zip | 75067-4519
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Country | US
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Telephone | 469-771-3151
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Fax | 469-771-3152
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Provider Business Mailing Address
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Address Line | 701 S STEMMONS FWY SUITE #230
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City | LEWISVILLE
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State | TX
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Zip | 75067-4547
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Country | US
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Telephone | 469-771-3151
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Fax | 469-771-3152
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | JIMI KLEMENTI
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Credential |
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Telephone | 469-771-3151
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31859
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License Number State | TX
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