MEDICARE: SAMANTHA ALEXANDER PHARMD

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	183500000X	Pharmacist	50205	TX

General Provider Information

NPI Number	:	1932487204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ALEXANDER PHARMD

Provider Business Mailing Address
First Line	:	5700 OVERTON RIDGE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3220
Country	:	US
Telephone Number	:	817-423-1661
Fax Number	:	817-423-1661

Provider Business Practice Location Address
First Line	:	5700 OVERTON RIDGE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3220
Country	:	US
Telephone Number	:	817-423-1661
Fax Number	:	817-423-1661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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