MEDICARE: REGENCY IHS PHARMACY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1043104458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY IHS PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	2310 GRAVEL DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-6950
Country	:	US
Telephone Number	:	817-562-0268
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 GRAVEL DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-6950
Country	:	US
Telephone Number	:	817-562-0268
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KERI LUKERT KRUPP
Credential	:
Telephone Number	:	512-695-7941

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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