Provider Demographics
NPI:1821316050
Name:WACHSMUTH, CHRISTINE RENEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:RENEE
Last Name:WACHSMUTH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:RENEE
Other - Last Name:SCHUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:103 ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-3014
Mailing Address - Country:US
Mailing Address - Phone:361-594-8164
Mailing Address - Fax:
Practice Address - Street 1:6106 N NAVARRO ST
Practice Address - Street 2:HEB PHARMACY #92
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1769
Practice Address - Country:US
Practice Address - Phone:361-572-4826
Practice Address - Fax:361-578-5476
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist