Provider Demographics
NPI:1770525305
Name:UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Entity type:Organization
Organization Name:UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:936-437-5363
Mailing Address - Street 1:2400 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5830
Mailing Address - Country:US
Mailing Address - Phone:936-437-5300
Mailing Address - Fax:936-437-5311
Practice Address - Street 1:2400 AVENUE I
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5830
Practice Address - Country:US
Practice Address - Phone:936-437-5300
Practice Address - Fax:936-437-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX204873336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098755OtherPK
4539625OtherOTHER ID NUMBER