Provider Demographics
NPI:1427633114
Name:STARKS, PATRICK WAYNE
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:WAYNE
Last Name:STARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10826 STONE CANYON RD APT 3315
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-4367
Mailing Address - Country:US
Mailing Address - Phone:469-383-6585
Mailing Address - Fax:
Practice Address - Street 1:10826 STONE CANYON RD APT 3315
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-4367
Practice Address - Country:US
Practice Address - Phone:469-383-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty