MEDICARE: TRI-PHASIC PHARMACY, INC.

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	22576	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4537152	OTHER	TX	NCPDP

General Provider Information

NPI Number	:	1689676488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-PHASIC PHARMACY, INC.

Provider Business Mailing Address
First Line	:	1700 TECH CENTRE PKWY
Second Line	:	SUITE #110-A1
City	:	ARLINGTON
State	:	TX
Zip	:	76014-4405
Country	:	US
Telephone Number	:	817-784-2400
Fax Number	:	817-676-9147

Provider Business Practice Location Address
First Line	:	1700 TECH CENTRE PKWY
Second Line	:	SUITE #110-A1
City	:	ARLINGTON
State	:	TX
Zip	:	76014-4405
Country	:	US
Telephone Number	:	817-784-2400
Fax Number	:	817-676-9147

Authorized Official
Title or Position	:	ACCOUNT COORDINATOR
Name	:	MS. AYESHA SIDDIQI
Credential	:
Telephone Number	:	817-784-2400

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	08/22/2020

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Directions to “TRI-PHASIC PHARMACY, INC. ” Practice Location

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