Provider Demographics
NPI:1194321216
Name:STAI, ROGER PAUL (RPH)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:PAUL
Last Name:STAI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 NE LOOP 564
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-2913
Mailing Address - Country:US
Mailing Address - Phone:903-569-5485
Mailing Address - Fax:
Practice Address - Street 1:135 NE LOOP 564
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-2913
Practice Address - Country:US
Practice Address - Phone:903-569-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist