MEDICARE: ERNEST TED ZIESCHANG RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	27970	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27970	OTHER	TX	TEXAS STATE BOARD OF PHARMACY LICENSE NUMBER

General Provider Information

NPI Number	:	1003420787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST TED ZIESCHANG RPH

Provider Business Mailing Address
First Line	:	10105 ONCILLA CT
Second Line	:
City	:	GODLEY
State	:	TX
Zip	:	76044
Country	:	US
Telephone Number	:	936-635-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S JIM WRIGHT FWY STE 102
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108-2681
Country	:	US
Telephone Number	:	866-361-0300
Fax Number	:	866-361-5900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/01/2020

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Directions to “ ERNEST TED ZIESCHANG RPH” Practice Location

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