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NPI Code Detail

MEDICARE: LOUIS M CALDWELL JR. R.PH.

MEDICARE: LOUIS M CALDWELL JR. R.PH.
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
1183500000XPharmacist28925TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1600002635OTHERTXRAILROAD MEDICARE MASS IMMUNIZER
2PH0374OTHERTXMEDICARE-MASS IMMUNIZER

General Provider Information

NPI Number : 1770840332
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOUIS M CALDWELL JR. R.PH.
Provider Business Mailing 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
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2012
Last Update Date : 05/19/2016

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