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General NPI Number Information
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NPI Number | 1174767362
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Entity Type | Organization
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Legal Business Name | FREDERICKSBURG LTC
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 707 N LLANO ST SUITE B
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-3943
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Country | US
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Telephone | 830-997-5800
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Fax | 830-997-0068
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Provider Business Mailing Address
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Address Line | 707 N LLANO ST SUITE B
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-3943
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Country | US
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Telephone | 830-997-5800
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Fax | 830-997-0068
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Authorized Official
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Title or Position | OWNER
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Name | WHITNEY ROBERTS
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Credential |
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Telephone | 830-997-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 26428
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License Number State | TX
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