Active NPI
Michael O Fadeyi, M.S., PHARMD
- Pharmacist
- Benbrook, TX
National Provider Identifier
1619974003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26313
- Practice address
- 6310 Southwest Blvd Ste 204
Benbrook, TX 76109-6916 - Phone
- (866) 869-7307
- Fax
- (817) 263-1116
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26313 | TX | Primary |
Addresses
Primary practice location
6310 Southwest Blvd Ste 204
Benbrook, TX 76109-6916
Mailing address
2860 Concho TRL
Fort Worth, TX 76118-7395
Phone (817) 726-2498
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26313 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1619974003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2860 CONCHO TRL",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761187395",
"telephone_number": "817-726-2498",
"fax_number": "817-589-1213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6310 SOUTHWEST BLVD STE 204",
"city": "BENBROOK",
"state": "TX",
"postal_code": "761096916",
"telephone_number": "866-869-7307",
"fax_number": "817-263-1116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FADEYI",
"first_name": "MICHAEL",
"middle_name": "O",
"name_prefix": "Dr.",
"credential": "M.S., PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-30",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "26313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benbrook, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.