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NPI Code Detail

MEDICARE: EDWIN J HAIDUSEK R.PH.

MEDICARE: EDWIN J HAIDUSEK R.PH.
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
1183500000XPharmacist17658TX

General Provider Information

NPI Number : 1619218476
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWIN J HAIDUSEK R.PH.
Provider Business Mailing Address
First Line : 1091 FOX LN
Second Line :
City : LOCKHART
State : TX
Zip : 78644-4274
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 403 S COLORADO ST
Second Line :
City : LOCKHART
State : TX
Zip : 78644-2702
Country : US
Telephone Number : 512-398-6797
Fax Number : 512-398-6998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2013
Last Update Date : 03/04/2013

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Directions to “ EDWIN J HAIDUSEK R.PH.” Practice Location

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