MEDICARE: INDUSTRIAL & FAMILY 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	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy	30061	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2153244	OTHER		PK

General Provider Information

NPI Number	:	1700269198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDUSTRIAL & FAMILY PHARMACY INC

Provider Business Mailing Address
First Line	:	2301 NE 28TH ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76106-7408
Country	:	US
Telephone Number	:	817-625-6265
Fax Number	:	817-625-6272

Provider Business Practice Location Address
First Line	:	2301 NE 28TH ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76106-7408
Country	:	US
Telephone Number	:	817-625-6265
Fax Number	:	817-625-6272

Authorized Official
Title or Position	:	OWNER,PIC,AO
Name	:	DEHSHID NOURIAN
Credential	:	RPH
Telephone Number	:	817-625-6265

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	12/08/2016

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Directions to “INDUSTRIAL & FAMILY PHARMACY INC ” Practice Location

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