Healthcare Provider Details

I. General information

NPI: 1063083103
Provider Name (Legal Business Name): NORMA OLVERA CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N MOUND ST
NACOGDOCHES TX
75961-4028
US

IV. Provider business mailing address

1205 N MOUND ST
NACOGDOCHES TX
75961-4028
US

V. Phone/Fax

Practice location:
  • Phone: 936-564-4646
  • Fax: 936-560-6675
Mailing address:
  • Phone: 936-564-4646
  • Fax: 936-560-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number245315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: