MEDICARE: WPMD 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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	28125	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2136587	OTHER		PK

General Provider Information

NPI Number	:	1083962963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WPMD LLC

Provider Business Mailing Address
First Line	:	3415 S COOPER ST
Second Line	:	STE 106
City	:	ARLINGTON
State	:	TX
Zip	:	76015-3446
Country	:	US
Telephone Number	:	817-642-5613
Fax Number	:	682-238-3686

Provider Business Practice Location Address
First Line	:	3415 S COOPER ST
Second Line	:	STE 106
City	:	ARLINGTON
State	:	TX
Zip	:	76015-3446
Country	:	US
Telephone Number	:	817-642-5613
Fax Number	:	682-238-3686

Authorized Official
Title or Position	:	OWNER
Name	:	THAI PHAM
Credential	:
Telephone Number	:	817-642-5613

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	03/20/2017

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Directions to “WPMD LLC ” Practice Location

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