MEDICARE: DR. HEPHZIBAH BEULAH FORSAC

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	60211	TX

General Provider Information

NPI Number	:	1629663976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEPHZIBAH BEULAH FORSAC

Provider Business Mailing Address
First Line	:	3101 CUARZO ST
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-6678
Country	:	US
Telephone Number	:	713-518-5532
Fax Number	:

Provider Business Practice Location Address
First Line	:	3914 N JACKSON RD
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-7768
Country	:	US
Telephone Number	:	956-305-2798
Fax Number	:	956-305-2887

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

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	07/20/2021

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