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NPI Code Detail

MEDICARE: DR. GRACIANY ALEXANDRE POSSU PHARM D

MEDICARE: DR. GRACIANY ALEXANDRE POSSU PHARM D
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
1183500000XPharmacist183500000X43909TX

General Provider Information

NPI Number : 1477880524
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRACIANY ALEXANDRE POSSU PHARM D
Provider Business Mailing Address
First Line : 4515 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76107
Country : US
Telephone Number : 817-735-8185
Fax Number : 817-735-8130
Provider Business Practice Location Address
First Line : 4515 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-3836
Country : US
Telephone Number : 817-735-8185
Fax Number : 817-735-8130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2009
Last Update Date : 11/11/2009

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