Provider Demographics
NPI:1376646174
Name:SHULTZ, BILL EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:EDWARD
Last Name:SHULTZ
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 1:111 MIDDLEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-9408
Mailing Address - Country:US
Mailing Address - Phone:903-786-2465
Mailing Address - Fax:
Practice Address - Street 1:930 MARTIN LUTHER KING ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2132
Practice Address - Country:US
Practice Address - Phone:903-465-0048
Practice Address - Fax:903-465-3492
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist