MEDICARE: MRS. ELLEN JANE SINATRA

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	183500000X	Pharmacist	28673	TX

General Provider Information

NPI Number	:	1053772947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN JANE SINATRA

Provider Business Mailing Address
First Line	:	9300 CLIFFORD ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4426
Country	:	US
Telephone Number	:	817-246-4909
Fax Number	:	817-246-3247

Provider Business Practice Location Address
First Line	:	9300 CLIFFORD ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4426
Country	:	US
Telephone Number	:	817-246-4909
Fax Number	:	817-246-3247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	03/18/2016

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