Healthcare Provider Details

I. General information

NPI: 1679781850
Provider Name (Legal Business Name): JENNIFER LYNN BOETTCHER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 HIGHWAY 290 E
ELGIN TX
78621-2519
US

IV. Provider business mailing address

609 W 2ND ST
ELGIN TX
78621-2130
US

V. Phone/Fax

Practice location:
  • Phone: 512-285-4719
  • Fax: 512-281-0507
Mailing address:
  • Phone: 512-281-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38669
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: