MEDICARE: AMC PHARMACY 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
1	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

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

General Provider Information

NPI Number	:	1386264547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMC PHARMACY INC.

Provider Business Mailing Address
First Line	:	2813 N COMMERCE ST STE 115
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-7245
Country	:	US
Telephone Number	:	682-703-1523
Fax Number	:	682-703-2028

Provider Business Practice Location Address
First Line	:	2813 N COMMERCE ST STE 115
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-7245
Country	:	US
Telephone Number	:	682-703-1523
Fax Number	:	682-703-2028

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	SODIENYE C HART
Credential	:	R.PH
Telephone Number	:	682-703-1523

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	08/04/2021

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Directions to “AMC PHARMACY INC. ” Practice Location

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