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General NPI Number Information
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NPI Number | 1992104194
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Entity Type | Organization
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Legal Business Name | SHATIFF PHARMACY INC
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 2771 E BROAD ST STE 219
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City | MANSFIELD
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State | TX
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Zip | 76063-9157
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Country | US
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Telephone | 817-225-4136
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Fax |
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Provider Business Mailing Address
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Address Line | 2771 E BROAD ST STE 219
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City | MANSFIELD
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State | TX
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Zip | 76063-9157
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Country | US
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Telephone | 817-225-4136
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Fax | 817-225-4138
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | AI-MY THI NGUYEN
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Credential | RPH
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Telephone | 817-225-4136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 29427
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License Number State | TX
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