Provider Demographics
NPI:1508108903
Name:GUNNOE, RICHARD BENTON SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BENTON
Last Name:GUNNOE
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 S PORT AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-2040
Mailing Address - Country:US
Mailing Address - Phone:361-883-1670
Mailing Address - Fax:361-883-2592
Practice Address - Street 1:3033 S PORT AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2040
Practice Address - Country:US
Practice Address - Phone:361-883-1670
Practice Address - Fax:361-883-2592
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist