MEDICARE: DME PHARMACY INFUSIONS

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	3336C0003X	Community/Retail Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	3336S0011X	Specialty Pharmacy	18760	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4547622	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1386813194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DME PHARMACY INFUSIONS

Provider Business Mailing Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	STE 103
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	STE 103
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-569-0015
Fax Number	:	817-370-7475

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MONI SAGOO
Credential	:
Telephone Number	:	817-800-3752

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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Directions to “DME PHARMACY INFUSIONS ” Practice Location

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