MEDICARE: MELVIN B MUSGROVE R.PH.

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	18416	TX

General Provider Information

NPI Number	:	1053884056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN B MUSGROVE R.PH.

Provider Business Mailing Address
First Line	:	607 W MAGNOLIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4608
Country	:	US
Telephone Number	:	817-688-7723
Fax Number	:	817-314-7227

Provider Business Practice Location Address
First Line	:	607 W MAGNOLIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4608
Country	:	US
Telephone Number	:	817-688-7723
Fax Number	:	817-314-7227

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

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	01/02/2019

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