Provider Demographics
NPI:1669709713
Name:ATKINS, ALEXANDER BENJAMIN
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:BENJAMIN
Last Name:ATKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 W BEDFORD EULESS RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3968
Mailing Address - Country:US
Mailing Address - Phone:817-282-0308
Mailing Address - Fax:817-282-1129
Practice Address - Street 1:201 COMMERCE ST STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-7206
Practice Address - Country:US
Practice Address - Phone:682-285-1100
Practice Address - Fax:682-285-1103
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist