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NPI Code Detail

MEDICARE: MARK WALDROP PHARMD

MEDICARE:   MARK  WALDROP  PHARMD
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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist61455TX

General Provider Information

NPI Number : 1043869209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK WALDROP PHARMD
Provider Business Mailing Address
First Line : 16750 WESTGROVE DR
Second Line :
City : ADDISON
State : TX
Zip : 75001-5688
Country : US
Telephone Number : 972-620-6048
Fax Number :
Provider Business Practice Location Address
First Line : 16750 WESTGROVE DR
Second Line :
City : ADDISON
State : TX
Zip : 75001-5688
Country : US
Telephone Number : 972-620-6048
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2019
Last Update Date : 09/10/2019

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