Healthcare Provider Details

I. General information

NPI: 1164024964
Provider Name (Legal Business Name): PAMELA CALDWELL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 HILLCREST DR
VERNON TX
76384-4099
US

IV. Provider business mailing address

4503 KENNEDY ST
VERNON TX
76384-7618
US

V. Phone/Fax

Practice location:
  • Phone: 940-552-2999
  • Fax: 940-552-5347
Mailing address:
  • Phone: 940-357-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31919
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: