Provider Demographics
NPI:1689903387
Name:TAXIS, JOHN OTTO V (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OTTO
Last Name:TAXIS
Suffix:V
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 1:1570 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-3816
Mailing Address - Country:US
Mailing Address - Phone:936-291-6764
Mailing Address - Fax:936-436-1773
Practice Address - Street 1:1570 11TH ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-3816
Practice Address - Country:US
Practice Address - Phone:936-291-6764
Practice Address - Fax:936-436-1773
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist