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General NPI Number Information
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NPI Number | 1154650877
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Entity Type | Individual
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Provider Name | MARK RICHARD BARRY DMD, RPH
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Gender | Male
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 1202 EVANS RD APT 1736
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City | SAN ANTONIO
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State | TX
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Zip | 78258-6974
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Country | US
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Telephone | 210-219-4524
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Fax | 210-219-4524
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Provider Business Mailing Address
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Address Line | PO BOX 591958
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City | SAN ANTONIO
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State | TX
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Zip | 78259-0147
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Country | US
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Telephone | 210-219-4524
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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 | 40373
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN21100
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License Number State | MA
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