Provider Demographics
NPI:1700269198
Name:INDUSTRIAL & FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:INDUSTRIAL & FAMILY PHARMACY INC
Other - Org Name:INDUSTRIAL & FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:DEHSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-625-6265
Mailing Address - Street 1:2301 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-7408
Mailing Address - Country:US
Mailing Address - Phone:817-625-6265
Mailing Address - Fax:817-625-6272
Practice Address - Street 1:2301 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-7408
Practice Address - Country:US
Practice Address - Phone:817-625-6265
Practice Address - Fax:817-625-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300613336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153244OtherPK