MEDICARE: MR. JOSEPH B STALLER R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	19969	TX

General Provider Information

NPI Number	:	1619028883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH B STALLER R.PH.

Provider Business Mailing Address
First Line	:	5139 BRAESVALLEY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-2609
Country	:	US
Telephone Number	:	713-822-3606
Fax Number	:	713-660-0119

Provider Business Practice Location Address
First Line	:	5139 BRAESVALLEY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-2609
Country	:	US
Telephone Number	:	713-822-3606
Fax Number	:	713-660-0119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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