MEDICARE: EDITH ACHEBODT

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	46810	TX

General Provider Information

NPI Number	:	1629679717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH ACHEBODT

Provider Business Mailing Address
First Line	:	1708 TAMARACK DR
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-8176
Country	:	US
Telephone Number	:	214-223-5041
Fax Number	:	972-205-9888

Provider Business Practice Location Address
First Line	:	2233 AVENUE J STE 103B
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-5884
Country	:	US
Telephone Number	:	972-205-9898
Fax Number	:	972-205-9888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	11/04/2020

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Directions to “ EDITH ACHEBODT ” Practice Location

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