Healthcare Provider Details

I. General information

NPI: 1679137970
Provider Name (Legal Business Name): AMY M GEBHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 S 14TH ST
ABILENE TX
79605-5015
US

IV. Provider business mailing address

3301 S 14TH ST
ABILENE TX
79605-5015
US

V. Phone/Fax

Practice location:
  • Phone: 325-698-7801
  • Fax: 325-698-3440
Mailing address:
  • Phone: 325-698-7801
  • Fax: 325-698-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number38667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: