MEDICARE: CAROL P FAWCETT 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
1	183500000X	Pharmacist	35081	TX

General Provider Information

NPI Number	:	1477881373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL P FAWCETT RPH

Provider Business Mailing Address
First Line	:	1700 RR 12
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-2502
Country	:	US
Telephone Number	:	512-393-3701
Fax Number	:	512-393-3707

Provider Business Practice Location Address
First Line	:	1700 RR 12
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-2502
Country	:	US
Telephone Number	:	512-393-3701
Fax Number	:	512-393-3707

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

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	12/03/2009

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