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General NPI Number Information
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NPI Number | 1497351415
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Entity Type | Individual
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Provider Name | CASEY VAUTERS
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Gender | Male
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Dates
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Enumeration Date | 12/06/2020
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Last Update Date | 12/06/2020
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Provider Practice Location Address
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Address Line | 601 N LOOP 274
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City | ANGLETON
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State | TX
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Zip | 77515-3256
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Country | US
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Telephone | 979-849-8294
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Fax | 979-864-3153
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Provider Business Mailing Address
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Address Line | 601 N LOOP 274
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City | ANGLETON
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State | TX
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Zip | 77515-3256
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Country | US
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Telephone | 979-849-8294
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Fax | 979-864-3153
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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 | 63223
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License Number State | TX
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