Provider Demographics
NPI:1811762511
Name:GASPER, LOVELY IZ-UNIQUE (RPHT)
Entity type:Individual
Prefix:
First Name:LOVELY
Middle Name:IZ-UNIQUE
Last Name:GASPER
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013 QUEENSTON BLVD APT 123
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7784
Mailing Address - Country:US
Mailing Address - Phone:281-892-9039
Mailing Address - Fax:
Practice Address - Street 1:1550 FRY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5813
Practice Address - Country:US
Practice Address - Phone:281-829-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312189183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician