MEDICARE: MRS. HALEY PHELPS MONTANARO 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	45954	TX
2	183500000X	Pharmacist	RPH022784	GA
3	183500000X	Pharmacist	E-09919	MS

General Provider Information

NPI Number	:	1326202128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HALEY PHELPS MONTANARO PHARMD

Provider Business Mailing Address
First Line	:	201 E CENTRAL TEXAS EXPY BLDG 3
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2747
Country	:	US
Telephone Number	:	254-953-5881
Fax Number	:	254-953-5881

Provider Business Practice Location Address
First Line	:	201 E CENTRAL TEXAS EXPY BLDG 3
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2747
Country	:	US
Telephone Number	:	254-953-5881
Fax Number	:	254-953-5881

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

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	07/11/2008

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