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General NPI Number Information
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NPI Number | 1881366821
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Entity Type | Individual
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Provider Name | WELTON POLVADO CPHT
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Gender | Male
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 5808 BURNET RD
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City | AUSTIN
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State | TX
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Zip | 78756-1100
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Country | US
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Telephone | 512-454-6691
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 W PARMER LN APT 3125
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City | AUSTIN
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State | TX
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Zip | 78729-4946
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Country | US
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Telephone |
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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 | 264205
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License Number State | TX
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