Provider Demographics
NPI:1154296465
Name:KRUEGER, MALLORY NICOLE
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:NICOLE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 ORION DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0193
Mailing Address - Country:US
Mailing Address - Phone:830-832-9329
Mailing Address - Fax:
Practice Address - Street 1:651 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5722
Practice Address - Country:US
Practice Address - Phone:830-609-1944
Practice Address - Fax:866-540-3837
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342810183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician