Provider Demographics
NPI:1770840332
Name:CALDWELL, LOUIS M JR (RPH)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
Last Name:CALDWELL
Suffix:JR
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 1:114 S OLD BETSY RD
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-2425
Mailing Address - Country:US
Mailing Address - Phone:817-558-3341
Mailing Address - Fax:817-641-8752
Practice Address - Street 1:114 S OLD BETSY RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-2425
Practice Address - Country:US
Practice Address - Phone:817-558-3341
Practice Address - Fax:817-641-8752
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600002635OtherRAILROAD MEDICARE MASS IMMUNIZER
TXPH0374OtherMEDICARE-MASS IMMUNIZER