Provider Demographics
NPI:1356640049
Name:GOSSMAN, GREGORY W (PHARM D)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:GOSSMAN
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 1:3921 HWY 377 SOUTH
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116
Mailing Address - Country:US
Mailing Address - Phone:817-738-2135
Mailing Address - Fax:817-763-8784
Practice Address - Street 1:3921 HWY 377 SOUTH
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116
Practice Address - Country:US
Practice Address - Phone:817-738-2135
Practice Address - Fax:817-763-8784
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313641835P0018X
WY18171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist