Provider Demographics
NPI:1548824675
Name:POWERS, PATRICK WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:WAYNE
Last Name:POWERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 US HIGHWAY 271 N
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-5580
Mailing Address - Country:US
Mailing Address - Phone:903-680-2600
Mailing Address - Fax:903-680-2605
Practice Address - Street 1:825 US HIGHWAY 271 N
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-5580
Practice Address - Country:US
Practice Address - Phone:903-680-2600
Practice Address - Fax:903-680-2605
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist