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General NPI Number Information
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NPI Number | 1184348294
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Entity Type | Individual
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Provider Name | KATHERINE MELANIE PERALTA BETETA
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 1800 BROWN BLVD
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City | ARLINGTON
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State | TX
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Zip | 76006-4602
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Country | US
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Telephone | 817-459-4066
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Fax |
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Provider Business Mailing Address
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Address Line | 705 IRISH GLEN DR
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City | ARLINGTON
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State | TX
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Zip | 76014-3214
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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 | 71349
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License Number State | TX
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