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General NPI Number Information
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NPI Number | 1609618966
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Entity Type | Individual
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Provider Name | LICAMIED CHALISE MACKLIN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2024
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 5950 SARATOGA BLVD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78414-4100
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Country | US
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Telephone | 613-985-5637
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Fax |
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Provider Business Mailing Address
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Address Line | 6685 LIPES BLVD APT 737
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City | CORPUS CHRISTI
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State | TX
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Zip | 78414-4516
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Country | US
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Telephone | 601-260-2411
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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 | 74071
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License Number State | TX
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