Provider Demographics
NPI:1750979662
Name:COOMES, STEPHEN (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:COOMES
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 1:6315 LONE STAR LN
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-3979
Mailing Address - Country:US
Mailing Address - Phone:940-391-1897
Mailing Address - Fax:940-440-0401
Practice Address - Street 1:701 S HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-5534
Practice Address - Country:US
Practice Address - Phone:940-440-0400
Practice Address - Fax:940-440-0401
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243403336C0003X
TX32773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy