Basic Information
| Provider Information | |||||||||
| NPI: | 1508213455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRISHAM-TAKAC | ||||||||
| FirstName: | CATLIN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9600 GOLF LAKES TRL | ||||||||
| Address2: | APT #1004 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752315029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9794501983 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1210 W BRAKER LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787583801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789300 | ||||||||
| FaxNumber: | 5122792556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2016 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P2201X | 56848 | TX | Y |
No ID Information.