Healthcare Provider Details

I. General information

NPI: 1386970010
Provider Name (Legal Business Name): WILFRED CECIL CROSS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2009
Last Update Date: 10/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 BUFFALO GAP RD
ABILENE TX
79606-4131
US

IV. Provider business mailing address

5201 BUFFALO GAP RD
ABILENE TX
79606-4131
US

V. Phone/Fax

Practice location:
  • Phone: 325-695-8664
  • Fax: 325-695-8764
Mailing address:
  • Phone: 325-695-8664
  • Fax: 325-695-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27596
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: