MEDICARE: GAYLE MARIE RADABAUGH RPH

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	24009	TX

General Provider Information

NPI Number	:	1912205519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE MARIE RADABAUGH RPH

Provider Business Mailing Address
First Line	:	7304 LOUETTA RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7234
Country	:	US
Telephone Number	:	281-379-1317
Fax Number	:

Provider Business Practice Location Address
First Line	:	7304 LOUETTA RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7234
Country	:	US
Telephone Number	:	281-379-1317
Fax Number	:

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

Provider Enumeration Date	:	03/05/2011
Last Update Date	:	03/05/2011

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