Healthcare Provider Details

I. General information

NPI: 1467792101
Provider Name (Legal Business Name): MICHELE MORAN MRACHEK R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2013
Last Update Date: 02/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 DENTON HWY
WATAUGA TX
76148-2464
US

IV. Provider business mailing address

8000 DENTON HWY
WATAUGA TX
76148-2464
US

V. Phone/Fax

Practice location:
  • Phone: 817-427-8039
  • Fax:
Mailing address:
  • Phone: 817-427-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49586
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12476
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31057
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21461
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: