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NPI Code Detail

MEDICARE: MR. BOBBY FANCHER R.PH.

MEDICARE: MR. BOBBY FANCHER 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
1183500000XPharmacist24640TX

General Provider Information

NPI Number : 1215264346
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BOBBY FANCHER R.PH.
Provider Business Mailing Address
First Line : 100 SE GREEN OAKS BLVD
Second Line :
City : ARLINGTON
State : TX
Zip : 76018-1640
Country : US
Telephone Number : 817-419-0585
Fax Number : 817-419-0583
Provider Business Practice Location Address
First Line : 100 SE GREEN OAKS BLVD
Second Line :
City : ARLINGTON
State : TX
Zip : 76018-1640
Country : US
Telephone Number : 817-419-0585
Fax Number : 817-419-0583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2009
Last Update Date : 11/10/2009

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