# FREDERICKSBURG LTC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fredericksburg LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174767362
- **Authorized official:** WHITNEY ROBERTS (OWNER)
- **Authorized official phone:** (830) 997-5800

## Contact information

- **Practice address:** 707 N LLANO ST, SUITE B, FREDERICKSBURG, TX 78624-3943
- **Practice address phone:** (830) 997-5800
- **Practice address fax:** (830) 997-0068
- **Mailing address:** 707 N LLANO ST, SUITE B, FREDERICKSBURG, TX 78624-3943
- **Mailing address phone:** (830) 997-5800
- **Mailing address fax:** (830) 997-0068

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 26428 | TX | Yes |

## Other

- **Enumeration date:** 05/01/2009
- **Last updated:** 03/01/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2120084 | PK | — |
| 05 | — | 350224 | — | TX |