Provider Demographics
NPI:1720489974
Name:BOUTTE, NATASHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:BOUTTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NATASHA
Other - Middle Name:DIANE
Other - Last Name:BOUTTE - NEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2812 SOUTH EXPRESSWAY 281
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2812 SOUTH EXPRESSWAY 281
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542
Practice Address - Country:US
Practice Address - Phone:956-252-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist