MEDICARE: A-1 DRUG MART 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	1863	TX
2	3336C0004X	Compounding Pharmacy	6331	CO
3	3336C0003X	Community/Retail Pharmacy	Y005812	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2096416	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790791531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A-1 DRUG MART INC

Provider Business Mailing Address
First Line	:	4821 RIVER OAKS BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76114-3097
Country	:	US
Telephone Number	:	817-626-3744
Fax Number	:	817-625-8103

Provider Business Practice Location Address
First Line	:	4821 RIVER OAKS BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76114-3097
Country	:	US
Telephone Number	:	817-626-3744
Fax Number	:	817-625-8103

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANDER SPENCE
Credential	:	PHARMACY
Telephone Number	:	817-676-3744

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	02/25/2014

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Directions to “A-1 DRUG MART INC ” Practice Location

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