MEDICARE: MONICA MARY HADDICAN

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	50591	TX

General Provider Information

NPI Number	:	1801149133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MARY HADDICAN

Provider Business Mailing Address
First Line	:	6020 DANNY KAYE DR
Second Line	:	APT 901
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1943
Country	:	US
Telephone Number	:	504-258-5086
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 DANNY KAYE DR
Second Line	:	APT 901
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1943
Country	:	US
Telephone Number	:	504-258-5086
Fax Number	:

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

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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