Provider Demographics
NPI:1699367151
Name:WETZ, GARY II (CPHT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:WETZ
Suffix:II
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16512 SPACE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2046
Mailing Address - Country:US
Mailing Address - Phone:903-271-3920
Mailing Address - Fax:
Practice Address - Street 1:3505 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-5078
Practice Address - Country:US
Practice Address - Phone:903-271-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174594183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician