Provider Demographics
NPI:1497367858
Name:PONTZER, DEVYN GISELLE (RPH)
Entity Type:Individual
Prefix:DR
First Name:DEVYN
Middle Name:GISELLE
Last Name:PONTZER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 N CARROLL AVE APT 3301
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3067
Mailing Address - Country:US
Mailing Address - Phone:972-801-7147
Mailing Address - Fax:
Practice Address - Street 1:2802 N CARROLL AVE APT 3301
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3067
Practice Address - Country:US
Practice Address - Phone:972-801-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist