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NPI Code Detail

MEDICARE: LOUIS M CALDWELL JR

MEDICARE: LOUIS M CALDWELL JR
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
1332B00000XDurable Medical Equipment & Medical Supplies
23336L0003XLong Term Care Pharmacy
3333600000XPharmacy
43336C0003XCommunity/Retail Pharmacy20155TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22098101OTHERPK

General Provider Information

NPI Number : 1417025214
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOUIS M CALDWELL JR
Provider Business Mailing Address
First Line : PO BOX 566
Second Line :
City : KEENE
State : TX
Zip : 76059-0566
Country : US
Telephone Number : 817-552-3341
Fax Number : 817-651-8452
Provider Business Practice Location Address
First Line : 114 S OLD BETSY RD
Second Line :
City : KEENE
State : TX
Zip : 76059-2425
Country : US
Telephone Number : 817-558-3341
Fax Number : 817-641-8752
Authorized Official
Title or Position : OWNER
Name : LOUIS CALDWELL
Credential : RPH
Telephone Number : 817-558-3341
Provider Enumeration Date : 12/01/2006
Last Update Date : 02/16/2017

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