Provider Demographics
NPI:1295197457
Name:ENLOE, MICHAEL THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:ENLOE
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 1:4410 MORGANS RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2163
Mailing Address - Country:US
Mailing Address - Phone:210-430-6639
Mailing Address - Fax:
Practice Address - Street 1:3603 PAESANOS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1268
Practice Address - Country:US
Practice Address - Phone:210-448-9098
Practice Address - Fax:210-764-1038
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22836OtherTEXAS STATE BOARD OF PHARMACY