Healthcare Provider Details

I. General information

NPI: 1124664156
Provider Name (Legal Business Name): AMY SUE CLINE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17130 HIGHWAY 46 W
SPRING BRANCH TX
78070-7092
US

IV. Provider business mailing address

2631 WINDING VW
SAN ANTONIO TX
78260-7258
US

V. Phone/Fax

Practice location:
  • Phone: 830-885-7770
  • Fax:
Mailing address:
  • Phone: 309-202-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: