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NPI Code Detail

MEDICARE: GERALYN VASUT RPH

MEDICARE: GERALYN VASUT 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
1183500000XPharmacist25949TX

General Provider Information

NPI Number : 1912225442
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALYN VASUT RPH
Provider Business Mailing Address
First Line : 637 E UPPERLINE
Second Line :
City : LA GRANGE
State : TX
Zip : 78945-1734
Country : US
Telephone Number : 979-966-8654
Fax Number :
Provider Business Practice Location Address
First Line : 450 E TRAVIS ST
Second Line :
City : LA GRANGE
State : TX
Zip : 78945-2655
Country : US
Telephone Number : 979-968-8677
Fax Number : 979-968-9625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2010
Last Update Date : 05/07/2010

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