Organization
ASCENSION PROVIDENCE
Active
Other names
Ascension Providence Plaza Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE L HOLLY (REG DIR NET REV & REIMB)
(210) 410-2789
Entity
Organization
Contact information
Practice address
405 LONDONDERRY DR STE 104, WACO, TX 76712-7920
(254) 751-4915
(254) 751-4916
Mailing address
405 LONDONDERRY DR STE 104, WACO, TX 76712-7920
(254) 751-4915
(254) 751-4916
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14491
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2099862
PK
—
05
—
370017
—
TX
Enumeration date
02/07/2007
Last updated
09/16/2025
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