=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902236581
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH MAXSON RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2013
-----------------------------------------------------
Last Update Date | 11/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9250 PINECROFT DR
-----------------------------------------------------
City | SHENANDOAH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-897-2731
-----------------------------------------------------
Fax | 713-897-2045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9250 PINECROFT DR
-----------------------------------------------------
City | SHENANDOAH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-897-2731
-----------------------------------------------------
Fax | 713-897-2045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835X0200X
-----------------------------------------------------
Taxonomy Name | Oncology Pharmacist
-----------------------------------------------------
License Number | 27927
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------