Fort Worth Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

30317 Issued in TX

Legal business name

FORT WORTH PHARMACY LLC

Practice address

7833 Oakmont Blvd
Suite 120
Fort Worth, TX 76132-4231

Phone

(817) 361-9960

Fax

(817) 361-9970

NPI assigned

Aug 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Creighton Maynard, BS

Title

Owner

Phone

(817) 361-9960

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• FORT WORTH PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1881708873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7833 OAKMONT BLVD",
            "address_2": "SUITE 120",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324231",
            "telephone_number": "817-361-9960",
            "fax_number": "817-361-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7833 OAKMONT BLVD",
            "address_2": "SUITE 120",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324231",
            "telephone_number": "817-361-9960",
            "fax_number": "817-361-9970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "MAYNARD",
        "authorized_official_first_name": "CREIGHTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-361-9960",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "30317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2099205",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FORT WORTH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providers in Fort Worth, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.