Healthcare Provider Details

I. General information

NPI: 1154968071
Provider Name (Legal Business Name): GINA PARIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HIGHWAY 199
SPRINGTOWN TX
76082-2755
US

IV. Provider business mailing address

PO BOX 29
AZLE TX
76098-0029
US

V. Phone/Fax

Practice location:
  • Phone: 817-220-1178
  • Fax: 866-547-6689
Mailing address:
  • Phone: 817-239-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11123
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33255
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: