MEDICARE: AI DINH

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	45432	TX

General Provider Information

NPI Number	:	1093122459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AI DINH

Provider Business Mailing Address
First Line	:	9114 CAMP BOWIE WEST BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6023
Country	:	US
Telephone Number	:	817-560-4233
Fax Number	:	817-244-8964

Provider Business Practice Location Address
First Line	:	9114 CAMP BOWIE WEST BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6023
Country	:	US
Telephone Number	:	817-560-4233
Fax Number	:	817-244-8964

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

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2014

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Directions to “ AI DINH ” Practice Location

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