MEDICARE: ALEXANDER BENJAMIN ATKINS

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	183500000X	Pharmacist	39694	TX

General Provider Information

NPI Number	:	1669709713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER BENJAMIN ATKINS

Provider Business Mailing Address
First Line	:	780 W BEDFORD EULESS RD
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-3968
Country	:	US
Telephone Number	:	817-282-0308
Fax Number	:	817-282-1129

Provider Business Practice Location Address
First Line	:	201 COMMERCE ST STE 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-7206
Country	:	US
Telephone Number	:	682-285-1100
Fax Number	:	682-285-1103

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

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	08/05/2022

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