Provider Demographics
NPI:1932104957
Name:TOWER MEDIC PHARMACY INC
Entity Type:Organization
Organization Name:TOWER MEDIC PHARMACY INC
Other - Org Name:TOWER MEDIC PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-336-8133
Mailing Address - Street 1:607 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4608
Mailing Address - Country:US
Mailing Address - Phone:817-336-8133
Mailing Address - Fax:817-314-7227
Practice Address - Street 1:607 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4608
Practice Address - Country:US
Practice Address - Phone:817-336-8133
Practice Address - Fax:817-314-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X, 3336S0011X
TX30743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2096534OtherPK
TX140068Medicaid
TX140068Medicaid