Provider Demographics
NPI:1558905711
Name:GONZALES, STEPHANIE OH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:OH
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 W NIRVANA CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-2109
Mailing Address - Country:US
Mailing Address - Phone:512-777-9939
Mailing Address - Fax:
Practice Address - Street 1:7213 W NIRVANA CIR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-2109
Practice Address - Country:US
Practice Address - Phone:512-777-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist