Healthcare Provider Details

I. General information

NPI: 1255074316
Provider Name (Legal Business Name): DESTINEE RAQUIEL OGAS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 04/17/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W WILLIAM CANNON DR
AUSTIN TX
78749-1794
US

IV. Provider business mailing address

6200 W WILLIAM CANNON DR
AUSTIN TX
78749-1794
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-1933
  • Fax:
Mailing address:
  • Phone: 512-892-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: