Provider Demographics
NPI:1770701518
Name:SCHULTZ, GARY LEE JR (PHARM D, RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:SCHULTZ
Suffix:JR
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DESERT WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-2717
Mailing Address - Country:US
Mailing Address - Phone:940-692-9907
Mailing Address - Fax:
Practice Address - Street 1:2522 IOWA PARK ROAD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306
Practice Address - Country:US
Practice Address - Phone:940-322-1114
Practice Address - Fax:940-767-3908
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist