Provider Demographics
NPI:1043104458
Name:REGENCY IHS PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:REGENCY IHS PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:LUKERT
Authorized Official - Last Name:KRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-695-7941
Mailing Address - Street 1:2310 GRAVEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-6950
Mailing Address - Country:US
Mailing Address - Phone:817-562-0268
Mailing Address - Fax:
Practice Address - Street 1:2310 GRAVEL DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-6950
Practice Address - Country:US
Practice Address - Phone:817-562-0268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy