MEDICARE: MR. GARRY GENE STEBBINS RPH

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	47058	TX

General Provider Information

NPI Number	:	1750692661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARRY GENE STEBBINS RPH

Provider Business Mailing Address
First Line	:	33840 S GARCIA ST UNIT 356
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-4331
Country	:	US
Telephone Number	:	574-286-2487
Fax Number	:

Provider Business Practice Location Address
First Line	:	1673 HIGHWAY 100
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-2806
Country	:	US
Telephone Number	:	956-943-3754
Fax Number	:

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	06/24/2010

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