MEDICARE: DR. DOROTHY ARCHIBONG PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	47690	TX

General Provider Information

NPI Number	:	1033447370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY ARCHIBONG PHARM.D.

Provider Business Mailing Address
First Line	:	5202 TEXANA DR APT 514
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3777
Country	:	US
Telephone Number	:	713-320-0418
Fax Number	:

Provider Business Practice Location Address
First Line	:	8202 CULEBRA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1686
Country	:	US
Telephone Number	:	210-543-8419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2009
Last Update Date	:	11/25/2009

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