Provider Demographics
NPI:1922724871
Name:HOOVER, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HOOVER
Suffix:
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 1:292 STONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-2635
Mailing Address - Country:US
Mailing Address - Phone:197-220-3204
Mailing Address - Fax:
Practice Address - Street 1:11820 ELAM RD
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-2746
Practice Address - Country:US
Practice Address - Phone:972-286-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX042388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist