Provider Demographics
NPI:1972924025
Name:GISCH, GLORIA (RPH)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:GISCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MCCANN AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4819
Mailing Address - Country:US
Mailing Address - Phone:512-608-1755
Mailing Address - Fax:
Practice Address - Street 1:240 MCCANN AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4819
Practice Address - Country:US
Practice Address - Phone:512-608-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25300183500000X
MO2011027157183500000X
WAPH 60036824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist