Provider Demographics
NPI:1972614360
Name:MENARD, JOHN STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEPHEN
Last Name:MENARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 LAUREL OAKS LN
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-2767
Mailing Address - Country:US
Mailing Address - Phone:254-848-4883
Mailing Address - Fax:254-867-0243
Practice Address - Street 1:2401 E WACO DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-3259
Practice Address - Country:US
Practice Address - Phone:254-799-4949
Practice Address - Fax:254-867-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist