Provider Demographics
NPI:1588253009
Name:CASTILLO, VENESSA LYNN (CPHT)
Entity type:Individual
Prefix:MISS
First Name:VENESSA
Middle Name:LYNN
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:TX
Mailing Address - Zip Code:78648-2918
Mailing Address - Country:US
Mailing Address - Phone:512-569-1596
Mailing Address - Fax:
Practice Address - Street 1:1841 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-2406
Practice Address - Country:US
Practice Address - Phone:830-672-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician