Provider Demographics
NPI:1023304540
Name:STIRNEMAN, BOBBY RAY
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:RAY
Last Name:STIRNEMAN
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 1:7608 NE ZAC LENTZ PKWY
Mailing Address - Street 2:T-0888
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7608 NE ZAC LENTZ PKWY
Practice Address - Street 2:T-0888
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1390
Practice Address - Country:US
Practice Address - Phone:361-579-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist