Provider Demographics
NPI:1821204876
Name:MCCRORY, GARY EDWIN (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:EDWIN
Last Name:MCCRORY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 DEW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3912
Mailing Address - Country:US
Mailing Address - Phone:915-203-6460
Mailing Address - Fax:915-587-6556
Practice Address - Street 1:6151 DEW DR STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3912
Practice Address - Country:US
Practice Address - Phone:915-203-6460
Practice Address - Fax:915-587-6556
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22895183500000X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22895OtherPHARMACIST LISCENSE #