Healthcare Provider Details

I. General information

NPI: 1124249933
Provider Name (Legal Business Name): ANNA M GAUTHIER RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOLCOMBE
HOUSTON TX
77004
US

IV. Provider business mailing address

2917 CHENEVERT
HOUSTON TX
77004
US

V. Phone/Fax

Practice location:
  • Phone: 713-794-5723
  • Fax:
Mailing address:
  • Phone: 713-750-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number29049
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: