Provider Demographics
NPI:1295158863
Name:MEYER, GERALD BRIAN (RPH)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:BRIAN
Last Name:MEYER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 SAN JOSE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8500
Mailing Address - Country:US
Mailing Address - Phone:940-594-5865
Mailing Address - Fax:432-363-4803
Practice Address - Street 1:700 N GRANT AVE STE 150
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4535
Practice Address - Country:US
Practice Address - Phone:432-606-2394
Practice Address - Fax:432-363-4803
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist