Provider Demographics
NPI:1518967975
Name:NORSTROM, PAMELA E (MS, RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:E
Last Name:NORSTROM
Suffix:
Gender:F
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BREEZE RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-5913
Mailing Address - Country:US
Mailing Address - Phone:210-579-3822
Mailing Address - Fax:210-442-4449
Practice Address - Street 1:4330 VANCE JACKSON RD
Practice Address - Street 2:NIX SPECIALTY HOSPITAL
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5321
Practice Address - Country:US
Practice Address - Phone:210-579-3822
Practice Address - Fax:210-443-4449
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26959OtherPHARMACIST LICENSE