Healthcare Provider Details

I. General information

NPI: 1417223561
Provider Name (Legal Business Name): NANCY VOGELGESANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BERGQUIST DR STE 1
LACKLAND A F B TX
78236-9908
US

IV. Provider business mailing address

2200 BERGQUIST DR STE 1
LACKLAND A F B TX
78236-9908
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-7412
  • Fax:
Mailing address:
  • Phone: 210-292-5882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number31408
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: