Basic Information
| Provider Information | |||||||||
| NPI: | 1528510716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCUIN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2104 | ||||||||
| Address2: | |||||||||
| City: | HARKER HEIGHTS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765480104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546990624 | ||||||||
| FaxNumber: | 2546696170 | ||||||||
| Practice Location | |||||||||
| Address1: | 3404 W STAN SCHLUETER LOOP | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765494705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546990624 | ||||||||
| FaxNumber: | 2546696170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2016 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
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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 | 1835P1200X | 38752 | TX | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
ID Information
| ID | Type | State | Issuer | Description | 38752 | 01 | TX | PHARMACY | OTHER |