MEDICARE: CONNIE RAEMSCH

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	30275	TX

General Provider Information

NPI Number	:	1588053888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE RAEMSCH

Provider Business Mailing Address
First Line	:	610 POPE BND N
Second Line	:
City	:	CEDAR CREEK
State	:	TX
Zip	:	78612-3485
Country	:	US
Telephone Number	:	512-940-2842
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 POPE BND N
Second Line	:
City	:	CEDAR CREEK
State	:	TX
Zip	:	78612-3485
Country	:	US
Telephone Number	:	512-940-2842
Fax Number	:

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

Provider Enumeration Date	:	01/10/2015
Last Update Date	:	01/10/2015

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Directions to “ CONNIE RAEMSCH ” Practice Location

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