Provider Demographics
NPI:1386972107
Name:STALLINGS, PAUL IMANNUEL (PHARM D)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:IMANNUEL
Last Name:STALLINGS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SAN PEDRO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6206
Mailing Address - Country:US
Mailing Address - Phone:210-349-9809
Mailing Address - Fax:210-349-5008
Practice Address - Street 1:6901 SAN PEDRO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6206
Practice Address - Country:US
Practice Address - Phone:210-349-9809
Practice Address - Fax:210-349-5008
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist