Provider Demographics
NPI:1518397025
Name:FW MEDICAL SUPPLIES, LLC D/B/A DANDY DRUG
Entity Type:Organization
Organization Name:FW MEDICAL SUPPLIES, LLC D/B/A DANDY DRUG
Other - Org Name:DANDY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-456-4348
Mailing Address - Street 1:5450 E FM 1187
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3060
Mailing Address - Country:US
Mailing Address - Phone:817-483-3784
Mailing Address - Fax:817-483-0568
Practice Address - Street 1:5450 E FM 1187
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3060
Practice Address - Country:US
Practice Address - Phone:817-483-3784
Practice Address - Fax:817-483-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX288913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142996OtherPK