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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 Pharmacy12278TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14574340OTHERTXNABP ID #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346328358
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINYARD FOOD STORES INC.
Provider Business Mailing Address
First Line : 3451 ALTAMESA BLVD
Second Line :
City : FT WORTH
State : TX
Zip : 76133-5701
Country : US
Telephone Number : 817-294-2517
Fax Number : 817-294-9678
Provider Business Practice Location Address
First Line : 3451 ALTAMESA BLVD
Second Line :
City : FT WORTH
State : TX
Zip : 76133-5701
Country : US
Telephone Number : 817-294-2517
Fax Number : 817-294-9678
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 : 11/16/2007

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