Basic Information
| Provider Information | |||||||||
| NPI: | 1003145186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PREWETT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | EDWARDS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | R.PH. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 513 E AUSTIN ST | ||||||||
| Address2: | |||||||||
| City: | GIDDINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789423305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9795423308 | ||||||||
| FaxNumber: | 9795421658 | ||||||||
| Practice Location | |||||||||
| Address1: | 513 E AUSTIN ST | ||||||||
| Address2: | |||||||||
| City: | GIDDINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789423305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9795423308 | ||||||||
| FaxNumber: | 9795421658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2009 | ||||||||
| LastUpdateDate: | 12/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 22924 | TX | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.