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NPI Code Detail

MEDICARE: MS. REGLA BUSTAMANTE PHARMD

MEDICARE:  MS. REGLA  BUSTAMANTE  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
1183500000XPharmacist48179TX

General Provider Information

NPI Number : 1962730176
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REGLA BUSTAMANTE PHARMD
Provider Business Mailing Address
First Line : 6346 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-5408
Country : US
Telephone Number : 817-377-9095
Fax Number :
Provider Business Practice Location Address
First Line : 6346 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-5408
Country : US
Telephone Number : 817-377-9095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2009
Last Update Date : 11/27/2009

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Directions to “ MS. REGLA BUSTAMANTE PHARMD” Practice Location

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