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General NPI Number Information
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NPI Number | 1578505145
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Entity Type | Organization
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Legal Business Name | STONEGATE PHARMACY LP
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 2501 W WILLIAM CANNON DR BLDG 2 STE 203
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City | AUSTIN
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State | TX
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Zip | 78745-5281
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Country | US
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Telephone | 512-707-2300
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Fax | 512-707-2378
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Provider Business Mailing Address
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Address Line | 2501 W WILLIAM CANNON DR BLDG 2 STE 203
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City | AUSTIN
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State | TX
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Zip | 78745-5281
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Country | US
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Telephone | 512-707-2300
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Fax | 512-707-2378
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | RENE GARZA
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Credential | PHARMD
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Telephone | 512-707-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 24369
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License Number State | TX
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