Individual
DALE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4715 WESLEY ST, GREENVILLE, TX 75401-5647
(903) 259-5292
Mailing address
6308 SMITHWICK DR, MCKINNEY, TX 75070-3570
(214) 717-1539
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
67314
TX
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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