Provider Demographics
NPI:1962195610
Name:KRUEGER, MELVIN ALVIN X
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:ALVIN
Last Name:KRUEGER
Suffix:X
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 PRIVATE ROAD 5936
Mailing Address - Street 2:
Mailing Address - City:YANTIS
Mailing Address - State:TX
Mailing Address - Zip Code:75497-3721
Mailing Address - Country:US
Mailing Address - Phone:903-819-1028
Mailing Address - Fax:
Practice Address - Street 1:122 WEST COLLIN STREET
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-1229
Practice Address - Country:US
Practice Address - Phone:903-587-3363
Practice Address - Fax:903-587-2714
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204751835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care