=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790455970
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN THOMAS GATZ PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2021
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6101 WINDHAVEN PKWY STE 125
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-8290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-677-7891
-----------------------------------------------------
Fax | 972-677-7536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6906 DAVIDSON ST APT 12
-----------------------------------------------------
City | THE COLONY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75056-5237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-999-0818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 68564
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------