Basic Information
| Provider Information | |||||||||
| NPI: | 1487251732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEINSCHMIDT, RPH | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | REGISTERED PHARMACIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3596 COUNTY ROAD 405 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789474939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9795427925 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 513 E AUSTIN ST | ||||||||
| Address2: | |||||||||
| City: | GIDDINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789423305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9795423308 | ||||||||
| FaxNumber: | 9795421658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2020 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 29524 | TX | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 29524 | 01 | TX | TEXAS STATE BOARD OF PHARMACY | OTHER |