Provider Demographics
NPI:1023544392
Name:GWYN, PAULINE GAIL
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:GAIL
Last Name:GWYN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PAULINE
Other - Middle Name:GAIL
Other - Last Name:BURGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:103 N LOOP 499
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2557
Mailing Address - Country:US
Mailing Address - Phone:956-230-7017
Mailing Address - Fax:
Practice Address - Street 1:103 N LOOP 499
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2557
Practice Address - Country:US
Practice Address - Phone:956-230-7017
Practice Address - Fax:956-425-0096
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist