MEDICARE: JILLIAN HENRY PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	51349	TX

General Provider Information

NPI Number	:	1316674138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN HENRY PHARM.D.

Provider Business Mailing Address
First Line	:	6020A HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4102
Country	:	US
Telephone Number	:	817-738-0722
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020A HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4102
Country	:	US
Telephone Number	:	817-738-0722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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