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General NPI Number Information
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NPI Number | 1912406695
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Entity Type | Individual
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Provider Name | MY LOI
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Gender | Male
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 1310 N COCKRELL HILL RD
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City | DALLAS
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State | TX
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Zip | 75211-1386
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Country | US
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Telephone | 214-430-0212
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 180961
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City | ARLINGTON
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State | TX
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Zip | 76096-0961
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Country | US
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Telephone |
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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 | 62110
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License Number State | TX
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