MEDICARE: DR. NANCY ANNE RADEBAUGH PHARMD

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	1835P1200X	Pharmacotherapy Pharmacist	9389	OK

General Provider Information

NPI Number	:	1538166699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY ANNE RADEBAUGH PHARMD

Provider Business Mailing Address
First Line	:	675 COLLEGE HILL DR
Second Line	:
City	:	SALADO
State	:	TX
Zip	:	76571-5624
Country	:	US
Telephone Number	:	254-947-1897
Fax Number	:

Provider Business Practice Location Address
First Line	:	36000 DARNALL LOOP
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-5095
Country	:	US
Telephone Number	:	254-286-7069
Fax Number	:

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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