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NPI Code Detail

MEDICARE: MINYARD FOOD STORES INC.

MEDICARE: MINYARD FOOD STORES INC.
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
13336C0003XCommunity/Retail Pharmacy12281TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14574275OTHERTXNABP ID#
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285711028
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINYARD FOOD STORES INC.
Provider Business Mailing Address
First Line : 4400 W GREEN OAKS BLVD
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-5608
Country : US
Telephone Number : 817-483-0777
Fax Number : 817-483-4157
Provider Business Practice Location Address
First Line : 4400 W GREEN OAKS BLVD
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-5608
Country : US
Telephone Number : 817-483-0777
Fax Number : 817-483-4157
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MR. MICHAEL D. BYARS
Credential :
Telephone Number : 972-393-8700
Provider Enumeration Date : 11/01/2006
Last Update Date : 11/15/2007

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Directions to “MINYARD FOOD STORES INC. ” Practice Location

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