Provider Demographics
NPI:1003420787
Name:ZIESCHANG, ERNEST TED (RPH)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:TED
Last Name:ZIESCHANG
Suffix:
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 1:10105 ONCILLA CT
Mailing Address - Street 2:
Mailing Address - City:GODLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76044
Mailing Address - Country:US
Mailing Address - Phone:936-635-9021
Mailing Address - Fax:
Practice Address - Street 1:401 S JIM WRIGHT FWY STE 102
Practice Address - Street 2:
Practice Address - City:WHITE SETTLEMENT
Practice Address - State:TX
Practice Address - Zip Code:76108-2681
Practice Address - Country:US
Practice Address - Phone:866-361-0300
Practice Address - Fax:866-361-5900
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279701835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27970OtherTEXAS STATE BOARD OF PHARMACY LICENSE NUMBER