MEDICARE: PATRICK WAYNE STARKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	46663	TX

General Provider Information

NPI Number	:	1427633114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK WAYNE STARKS

Provider Business Mailing Address
First Line	:	10826 STONE CANYON RD APT 3315
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-4367
Country	:	US
Telephone Number	:	469-383-6585
Fax Number	:

Provider Business Practice Location Address
First Line	:	10826 STONE CANYON RD APT 3315
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-4367
Country	:	US
Telephone Number	:	469-383-6585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2021
Last Update Date	:	03/14/2021

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Directions to “ PATRICK WAYNE STARKS ” Practice Location

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