Provider Demographics
NPI:1184843815
Name:GOULAS, SHANE J (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:J
Last Name:GOULAS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2255 BRAESWOOD PARK DR
Mailing Address - Street 2:#331
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4454
Mailing Address - Country:US
Mailing Address - Phone:713-819-9296
Mailing Address - Fax:713-218-0772
Practice Address - Street 1:2626 SOUTH LOOP W
Practice Address - Street 2:STE 170
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2654
Practice Address - Country:US
Practice Address - Phone:713-218-0201
Practice Address - Fax:713-218-0772
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist