MEDICARE: ELIZABETH THEOPHILOS RPH

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	046601	NY
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	16022	CO
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	40434	TX

General Provider Information

NPI Number	:	1669071874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH THEOPHILOS RPH

Provider Business Mailing Address
First Line	:	7201 GRAPEVINE HWY
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8605
Country	:	US
Telephone Number	:	817-281-8310
Fax Number	:	817-427-8281

Provider Business Practice Location Address
First Line	:	7201 GRAPEVINE HWY
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8605
Country	:	US
Telephone Number	:	817-281-8310
Fax Number	:	817-427-8281

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

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	10/19/2020

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Directions to “ ELIZABETH THEOPHILOS RPH” Practice Location

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