Provider Demographics
NPI:1710579248
Name:ROYSTER, JAMES MICHAEL
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:ROYSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5484
Mailing Address - Country:US
Mailing Address - Phone:915-539-4169
Mailing Address - Fax:
Practice Address - Street 1:325 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-5484
Practice Address - Country:US
Practice Address - Phone:915-539-4169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30104371183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician