MEDICARE: BEST VALUE CUSTOM MEDS

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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy	26251	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4550821	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1568609949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEST VALUE CUSTOM MEDS

Provider Business Mailing Address
First Line	:	106 SW 6TH AVE
Second Line	:
City	:	MINERAL WELLS
State	:	TX
Zip	:	76067-5129
Country	:	US
Telephone Number	:	940-325-0734
Fax Number	:	940-328-1991

Provider Business Practice Location Address
First Line	:	6020 B HARRIS PARKWAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-292-2338
Fax Number	:	817-361-1552

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	ROBERT STEVEN WADDY
Credential	:	RPH
Telephone Number	:	940-325-0734

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	12/16/2024

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