Provider Demographics
NPI:1215532403
Name:AVERHOFF, MARCIA KAY
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:KAY
Last Name:AVERHOFF
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 1:4392 COUNTY ROAD 229
Mailing Address - Street 2:
Mailing Address - City:HICO
Mailing Address - State:TX
Mailing Address - Zip Code:76457-3522
Mailing Address - Country:US
Mailing Address - Phone:254-485-9449
Mailing Address - Fax:
Practice Address - Street 1:2765 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3740
Practice Address - Country:US
Practice Address - Phone:254-968-0660
Practice Address - Fax:254-968-7012
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist