MEDICARE: AP PHARMACY LLC

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
2	3336C0003X	Community/Retail Pharmacy	18235	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700984358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AP PHARMACY LLC

Provider Business Mailing Address
First Line	:	2329 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111
Country	:	US
Telephone Number	:	817-838-2319
Fax Number	:	817-838-9577

Provider Business Practice Location Address
First Line	:	2329 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-2904
Country	:	US
Telephone Number	:	817-838-2319
Fax Number	:	817-838-9577

Authorized Official
Title or Position	:	OFFICER
Name	:	MANOHAR MIRYALA
Credential	:
Telephone Number	:	817-838-2319

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/11/2021

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Directions to “AP PHARMACY LLC ” Practice Location

Language	Start Address	Practice Location

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