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General NPI Number Information
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NPI Number | 1154968071
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Entity Type | Individual
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Provider Name | GINA PARIS
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Gender | Female
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 501 E HIGHWAY 199
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City | SPRINGTOWN
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State | TX
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Zip | 76082-2755
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Country | US
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Telephone | 817-220-1178
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Fax | 866-547-6689
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Provider Business Mailing Address
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Address Line | PO BOX 29
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City | AZLE
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State | TX
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Zip | 76098-0029
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Country | US
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Telephone | 817-239-6892
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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 | 11123
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 33255
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License Number State | TX
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