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General NPI Number Information
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NPI Number | 1972159614
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Entity Type | Individual
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Provider Name | JAN HOLLEY PATTILLO RPH
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Gender | Female
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 107 N RICE ST
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City | HAMILTON
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State | TX
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Zip | 76531-1857
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Country | US
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Telephone | 254-386-3111
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Fax | 254-386-8844
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | HAMILTON
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State | TX
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Zip | 76531-0112
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Country | US
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Telephone | 254-386-3111
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Fax | 254-386-8844
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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 | TX28590
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License Number State | TX
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