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General NPI Number Information
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NPI Number | 1790122109
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Entity Type | Individual
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Provider Name | KATHERINE E ILTIS PHARMD.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 05/24/2013
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Provider Practice Location Address
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Address Line | 2525 W ANDERSON LN BLDG 2
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City | AUSTIN
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State | TX
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Zip | 78757-1180
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Country | US
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Telephone | 210-355-2956
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Fax |
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Provider Business Mailing Address
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Address Line | 6910 HART LN #803
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City | AUSTIN
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State | TX
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Zip | 78731-4150
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Country | US
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Telephone | 210-355-2956
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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 | 51957
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License Number State | TX
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