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General NPI Number Information
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NPI Number | 1003446394
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Entity Type | Individual
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Provider Name | ELYSE STUBBLEFIELD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/25/2020
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Last Update Date | 01/25/2020
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Provider Practice Location Address
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Address Line | 5241 N TARRANT PKWY
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City | FORT WORTH
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State | TX
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Zip | 76244-6292
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Country | US
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Telephone | 817-380-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 316 RUNNING WATER TRL
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City | FORT WORTH
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State | TX
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Zip | 76131-4611
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Country | US
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Telephone | 832-606-7743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 50878
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License Number State | TX
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