Healthcare Provider Details

I. General information

NPI: 1821204876
Provider Name (Legal Business Name): GARY EDWIN MCCRORY R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 DEW DR STE 100
EL PASO TX
79912-3912
US

IV. Provider business mailing address

6151 DEW DR STE 100
EL PASO TX
79912-3912
US

V. Phone/Fax

Practice location:
  • Phone: 915-203-6460
  • Fax: 915-587-6556
Mailing address:
  • Phone: 915-203-6460
  • Fax: 915-587-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22895
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number22895
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number22895
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: