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NPI Code Detail

MEDICARE: MRS. HOLLY ELAINE OUELLETTE RPH

MEDICARE: MRS. HOLLY ELAINE OUELLETTE 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
1183500000XPharmacist37649TX

General Provider Information

NPI Number : 1164716460
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HOLLY ELAINE OUELLETTE RPH
Provider Business Mailing Address
First Line : 22832 US HIGHWAY 281 N
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-7430
Country : US
Telephone Number : 210-679-2369
Fax Number : 210-679-2379
Provider Business Practice Location Address
First Line : 22832 US HIGHWAY 281 N
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-7430
Country : US
Telephone Number : 210-679-2369
Fax Number : 210-679-2379
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2011
Last Update Date : 06/03/2011

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