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NPI Code Detail

MEDICARE: CHRISTINA E FOMUSO PHARMACIST

MEDICARE: CHRISTINA E FOMUSO PHARMACIST
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
1183500000XPharmacist60112TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
160112OTHERBOARD OF PHARMACY

General Provider Information

NPI Number : 1952669590
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA E FOMUSO PHARMACIST
Provider Business Mailing Address
First Line : 1902 RICHMOND RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-2425
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1902 RICHMOND RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-2425
Country : US
Telephone Number : 903-838-3988
Fax Number : 909-838-4013
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2012
Last Update Date : 08/20/2020

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Directions to “ CHRISTINA E FOMUSO PHARMACIST” Practice Location

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