| NPI | 1023193158 |
|---|---|
| Other Name | IVMEDCO FORT WORTH |
| Entity Type | Organization |
| Authorized Contact | MANOHAR MIRYALA Officer 817-921-1957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: TX 13332) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2021-06-14 |