Provider Demographics
NPI:1578871166
Name:PRIDE, STONEY RANDALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STONEY
Middle Name:RANDALL
Last Name:PRIDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WEST FERGUSON STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455
Mailing Address - Country:US
Mailing Address - Phone:903-572-0486
Mailing Address - Fax:903-572-0380
Practice Address - Street 1:203 WEST FERGUSON STREET
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455
Practice Address - Country:US
Practice Address - Phone:903-572-0486
Practice Address - Fax:903-572-0380
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183500000XOtherTAXONOMY