Provider Demographics
NPI:1881137453
Name:BARKSDALE, GINA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 TEAL ST
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-0105
Mailing Address - Country:US
Mailing Address - Phone:817-751-2568
Mailing Address - Fax:682-708-5596
Practice Address - Street 1:1306 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1206
Practice Address - Country:US
Practice Address - Phone:214-948-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2024-02-19
Deactivation Date:2020-07-13
Deactivation Code:
Reactivation Date:2023-10-04
Provider Licenses
StateLicense IDTaxonomies
TX294871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist