Provider Demographics
NPI:1588053888
Name:RAEMSCH, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:RAEMSCH
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 1:610 POPE BND N
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78612-3485
Mailing Address - Country:US
Mailing Address - Phone:512-940-2842
Mailing Address - Fax:
Practice Address - Street 1:610 POPE BND N
Practice Address - Street 2:
Practice Address - City:CEDAR CREEK
Practice Address - State:TX
Practice Address - Zip Code:78612-3485
Practice Address - Country:US
Practice Address - Phone:512-940-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist