Provider Demographics
NPI:1104261734
Name:WIREBAUGH, STEWART ROSS (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:ROSS
Last Name:WIREBAUGH
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S BUSINESS IH 35
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4794
Mailing Address - Country:US
Mailing Address - Phone:830-387-5463
Mailing Address - Fax:
Practice Address - Street 1:607 S BUSINESS IH 35
Practice Address - Street 2:SUITE C
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4794
Practice Address - Country:US
Practice Address - Phone:830-387-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339141835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist