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General NPI Number Information
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NPI Number | 1487169280
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Entity Type | Individual
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Provider Name | BETTY ACHIENG AJUOGA PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 1201 S MAIN ST
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City | BOERNE
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State | TX
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Zip | 78006-2833
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Country | US
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Telephone | 830-357-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 635 SAGE THRASHER
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4589
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Country | US
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Telephone | 682-241-3702
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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 | 61424
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License Number State | TX
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