Provider Demographics
NPI:1750692661
Name:STEBBINS, GARRY GENE (RPH)
Entity type:Individual
Prefix:MR
First Name:GARRY
Middle Name:GENE
Last Name:STEBBINS
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 1:33840 S GARCIA ST UNIT 356
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-4331
Mailing Address - Country:US
Mailing Address - Phone:574-286-2487
Mailing Address - Fax:
Practice Address - Street 1:1673 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2806
Practice Address - Country:US
Practice Address - Phone:956-943-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist