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General NPI Number Information
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NPI Number | 1134321425
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Entity Type | Individual
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Provider Name | CAROLYN MARIE POLK
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1525 W CAMERON AVE
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City | ROCKDALE
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State | TX
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Zip | 76567-2606
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Country | US
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Telephone | 512-446-3220
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Fax | 512-446-3926
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Provider Business Mailing Address
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Address Line | 2234 COUNTY ROAD 434 LOOP
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City | ROCKDALE
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State | TX
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Zip | 76567-5431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 33429
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License Number State | TX
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