Provider Demographics
NPI:1164024964
Name:CALDWELL, PAMELA (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-7618
Mailing Address - Country:US
Mailing Address - Phone:940-357-0710
Mailing Address - Fax:
Practice Address - Street 1:1720 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4099
Practice Address - Country:US
Practice Address - Phone:940-552-2999
Practice Address - Fax:940-552-5347
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist