Provider Demographics
NPI:1891284253
Name:FAUCHER, ERNIE
Entity Type:Individual
Prefix:
First Name:ERNIE
Middle Name:
Last Name:FAUCHER
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 1:3264 SANIBEL CT
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2432
Mailing Address - Country:US
Mailing Address - Phone:512-659-4795
Mailing Address - Fax:
Practice Address - Street 1:3264 SANIBEL CT
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2432
Practice Address - Country:US
Practice Address - Phone:512-659-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist