Provider Demographics
NPI:1760710594
Name:MIESCH, CHRISTY L (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:MIESCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 BEE CAVE PKWY
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6382
Mailing Address - Country:US
Mailing Address - Phone:512-263-0570
Mailing Address - Fax:
Practice Address - Street 1:12200 BEE CAVE PKWY
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6382
Practice Address - Country:US
Practice Address - Phone:512-263-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist