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General NPI Number Information
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NPI Number | 1861516205
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Entity Type | Individual
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Provider Name | REBECCA ELIZABETH PEGUES PHARMACY TECH
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 1469 W STATE HIGHWAY 114 SUITE # 598
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City | GRAPEVINE
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State | TX
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Zip | 76051-8625
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Country | US
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Telephone | 817-571-8745
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Fax |
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Provider Business Mailing Address
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Address Line | 304 RANDY RD
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City | ROANOKE
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State | TX
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Zip | 76262-6149
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Country | US
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Telephone | 817-807-1443
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 2301-0102-0754-276
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License Number State | TX
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