=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376646174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BILL EDWARD SHULTZ RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 MARTIN LUTHER KING ST
-----------------------------------------------------
City | DENISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75020-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-465-0048
-----------------------------------------------------
Fax | 903-465-3492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 MIDDLEFIELD DR
-----------------------------------------------------
City | POTTSBORO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75076-9408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-786-2465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 20672
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------