Provider Demographics
NPI:1487981486
Name:BERRY, STEWART (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5568
Mailing Address - Country:US
Mailing Address - Phone:972-723-8408
Mailing Address - Fax:972-723-1567
Practice Address - Street 1:1481 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5568
Practice Address - Country:US
Practice Address - Phone:972-723-8408
Practice Address - Fax:972-723-1567
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist