Provider Demographics
NPI:1083923312
Name:DFW ATLANTEX LLC
Entity Type:Organization
Organization Name:DFW ATLANTEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:RASHID
Authorized Official - Last Name:HATTAB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-966-0140
Mailing Address - Street 1:11751 ALTA VISTA RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6441
Mailing Address - Country:US
Mailing Address - Phone:817-431-1010
Mailing Address - Fax:817-518-9298
Practice Address - Street 1:11751 ALTA VISTA RD
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6441
Practice Address - Country:US
Practice Address - Phone:817-431-1010
Practice Address - Fax:817-518-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy