Healthcare Provider Details

I. General information

NPI: 1659712347
Provider Name (Legal Business Name): RAELENE MARIE SHOWERY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY STA STOP A1910
AUSTIN TX
78712-0124
US

IV. Provider business mailing address

12056 VAN DYKE CT
EL PASO TX
79936-6300
US

V. Phone/Fax

Practice location:
  • Phone: 915-487-7396
  • Fax:
Mailing address:
  • Phone: 915-487-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number51846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: