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NPI Code Detail

MEDICARE: TRACY BONSU PHARMD RPH

MEDICARE: TRACY BONSU PHARMD RPH
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
1183500000XPharmacist53343TX

General Provider Information

NPI Number : 1124405170
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY BONSU PHARMD RPH
Provider Business Mailing Address
First Line : 1000 N COOPER STREET
Second Line :
City : ARLINGTON
State : TX
Zip : 76011
Country : US
Telephone Number : 469-438-7855
Fax Number : 469-283-2418
Provider Business Practice Location Address
First Line : 1000 N COOPER ST
Second Line :
City : ARLINGTON
State : TX
Zip : 76011-5540
Country : US
Telephone Number : 817-548-3474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2015
Last Update Date : 04/29/2015

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Directions to “ TRACY BONSU PHARMD RPH” Practice Location

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