1821316050 NPI number — MRS. CHRISTINE RENEE WACHSMUTH R.PH.

Table of content: MRS. CHRISTINE RENEE WACHSMUTH R.PH. (NPI 1821316050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821316050 NPI number — MRS. CHRISTINE RENEE WACHSMUTH R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WACHSMUTH
Provider First Name:
CHRISTINE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHUBERT
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.PH.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821316050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 ARKANSAS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHINER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77984-3014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-594-8164
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6106 N NAVARRO ST
Provider Second Line Business Practice Location Address:
HEB PHARMACY #92
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77904-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-572-4826
Provider Business Practice Location Address Fax Number:
361-578-5476
Provider Enumeration Date:
05/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  36377 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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