Provider Demographics
NPI:1336141985
Name:STORSETH, DICK PAUL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DICK
Middle Name:PAUL
Last Name:STORSETH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1810
Mailing Address - Country:US
Mailing Address - Phone:806-352-5624
Mailing Address - Fax:806-353-9270
Practice Address - Street 1:2600 W 22ND AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1810
Practice Address - Country:US
Practice Address - Phone:806-352-5624
Practice Address - Fax:806-353-9270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist