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NPI Code Detail

MEDICARE: DR. KHUMPHAN AMARATANA PHARM.D.

MEDICARE: DR. KHUMPHAN AMARATANA PHARM.D.
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
1183500000XPharmacist57467TX

General Provider Information

NPI Number : 1881059517
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KHUMPHAN AMARATANA PHARM.D.
Provider Business Mailing Address
First Line : 3809 E BELKNAP ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76111-6013
Country : US
Telephone Number : 817-834-7283
Fax Number : 817-834-9868
Provider Business Practice Location Address
First Line : 3809 E BELKNAP ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76111-6013
Country : US
Telephone Number : 817-834-7283
Fax Number : 817-834-9868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2015
Last Update Date : 12/26/2022

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