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General NPI Number Information
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NPI Number | 1255297198
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Entity Type | Individual
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Provider Name | MR. ROFONIE WHEATFALL JR.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 2005 HIGHWAY 90
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City | LIBERTY
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State | TX
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Zip | 77575-5817
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Country | US
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Telephone | 346-233-6185
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Fax |
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Provider Business Mailing Address
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Address Line | 8310 LOTEBUSH LN
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City | BAYTOWN
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State | TX
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Zip | 77523-2387
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 3436912
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License Number State | TX
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