MEDICARE: MR. FRED TINDEL 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	20310	TX

General Provider Information

NPI Number	:	1245612738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED TINDEL R.PH.

Provider Business Mailing Address
First Line	:	7400 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3904
Country	:	US
Telephone Number	:	817-423-9569
Fax Number	:	817-423-9582

Provider Business Practice Location Address
First Line	:	7400 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3904
Country	:	US
Telephone Number	:	817-423-9569
Fax Number	:	817-423-9582

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/23/2015

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