Healthcare Provider Details

I. General information

NPI: 1083626857
Provider Name (Legal Business Name): NANCY L SMALL PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S 1ST ST
TEMPLE TX
76504-7451
US

IV. Provider business mailing address

508 GIBRALTAR LN
LORENA TX
76655-9669
US

V. Phone/Fax

Practice location:
  • Phone: 254-778-4811
  • Fax:
Mailing address:
  • Phone: 254-857-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number1496
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: