MEDICARE: DR. ANDRE D BUDGEWATER 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
1	183500000X	Pharmacist	55042	TX

General Provider Information

NPI Number	:	1083221410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE D BUDGEWATER PHARMD

Provider Business Mailing Address
First Line	:	2228 ISLAND BYU
Second Line	:
City	:	BONHAM
State	:	TX
Zip	:	75418-2207
Country	:	US
Telephone Number	:	903-583-2887
Fax Number	:	903-583-2122

Provider Business Practice Location Address
First Line	:	2228 ISLAND BYU
Second Line	:
City	:	BONHAM
State	:	TX
Zip	:	75418-2207
Country	:	US
Telephone Number	:	903-583-2887
Fax Number	:	903-583-2122

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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