Healthcare Provider Details

I. General information

NPI: 1255855250
Provider Name (Legal Business Name): KATIE ELIZABETH HAY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ELIZABETH BOHMFALK

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 FM 471 W
SAN ANTONIO TX
78250
US

IV. Provider business mailing address

9255 FM 471 W
SAN ANTONIO TX
78250
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-2958
  • Fax: 210-509-0338
Mailing address:
  • Phone: 210-680-2958
  • Fax: 210-509-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60892
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: