MEDICARE: PAUL R ANDERSON PHARMACIST

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	18095	TX

General Provider Information

NPI Number	:	1851301519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL R ANDERSON PHARMACIST

Provider Business Mailing Address
First Line	:	1719 TWELVE OAKS DR
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2232
Country	:	US
Telephone Number	:	409-935-5507
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 TWELVE OAKS DR
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2232
Country	:	US
Telephone Number	:	409-935-5507
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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Directions to “ PAUL R ANDERSON PHARMACIST” Practice Location

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