Provider Demographics
NPI:1003145186
Name:PREWETT, JOHN EDWARDS JR (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARDS
Last Name:PREWETT
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 E AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-3305
Mailing Address - Country:US
Mailing Address - Phone:979-542-3308
Mailing Address - Fax:979-542-1658
Practice Address - Street 1:513 E AUSTIN ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-3305
Practice Address - Country:US
Practice Address - Phone:979-542-3308
Practice Address - Fax:979-542-1658
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist