Provider Demographics
NPI:1760056303
Name:STEWART, JERRY NEIL JR
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:NEIL
Last Name:STEWART
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 HARRISBURG BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-4016
Mailing Address - Country:US
Mailing Address - Phone:713-224-6504
Mailing Address - Fax:713-224-7413
Practice Address - Street 1:4516 HARRISBURG BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-4016
Practice Address - Country:US
Practice Address - Phone:713-224-6504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist