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General NPI Number Information
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NPI Number | 1568924629
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Entity Type | Individual
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Provider Name | CODY PAUL FRAUSTO PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 3300 I 40 E
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City | AMARILLO
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State | TX
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Zip | 79103-4801
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Country | US
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Telephone | 806-373-8722
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Fax | 806-373-6918
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Provider Business Mailing Address
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Address Line | 9310 GASTON AVE
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City | AMARILLO
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State | TX
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Zip | 79119-6236
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Country | US
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Telephone | 806-338-0818
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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 | 58600
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License Number State | TX
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