Provider Demographics
NPI:1831638543
Name:ZAGALA, DEBORAH MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIE
Last Name:ZAGALA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6526
Mailing Address - Country:US
Mailing Address - Phone:817-689-3602
Mailing Address - Fax:
Practice Address - Street 1:3310 BRIDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6526
Practice Address - Country:US
Practice Address - Phone:817-689-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33750183500000X
OK14239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK14239OtherOKLAHOMA STATE BOARD OF PHARMACY
TX33750OtherTEXAS STATE BOARD OF PHARMACY