Provider Demographics
NPI:1093137077
Name:CALDWELL, JIM B JR (RPH)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:B
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:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-0817
Mailing Address - Country:US
Mailing Address - Phone:325-625-9448
Mailing Address - Fax:325-625-5552
Practice Address - Street 1:312 S COMMERCIAL AVE
Practice Address - Street 2:13575 ST. HIGHWAY 206 SOUTH
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4214
Practice Address - Country:US
Practice Address - Phone:325-625-9448
Practice Address - Fax:325-625-5552
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist