Provider Demographics
NPI:1619028883
Name:STALLER, JOSEPH B (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:B
Last Name:STALLER
Suffix:
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 1:5139 BRAESVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2609
Mailing Address - Country:US
Mailing Address - Phone:713-822-3606
Mailing Address - Fax:713-660-0119
Practice Address - Street 1:5139 BRAESVALLEY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-2609
Practice Address - Country:US
Practice Address - Phone:713-822-3606
Practice Address - Fax:713-660-0119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist