Healthcare Provider Details

I. General information

NPI: 1730291089
Provider Name (Legal Business Name): PATRICIA ANN TABOR PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S 31ST ST
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

PO BOX 690
GEORGETOWN TX
78627-0690
US

V. Phone/Fax

Practice location:
  • Phone: 254-215-9117
  • Fax: 254-215-9106
Mailing address:
  • Phone: 254-215-9117
  • Fax: 254-215-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number24870
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: