MEDICARE: ARLENE BULAN JAEGERS PHARMACIST

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	65384	TX

General Provider Information

NPI Number	:	1558943092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLENE BULAN JAEGERS PHARMACIST

Provider Business Mailing Address
First Line	:	9620 WHITE SETTLEMENT RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4412
Country	:	US
Telephone Number	:	817-246-2411
Fax Number	:	817-246-2621

Provider Business Practice Location Address
First Line	:	9620 WHITE SETTLEMENT RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4412
Country	:	US
Telephone Number	:	817-246-2411
Fax Number	:	817-246-2621

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

Provider Enumeration Date	:	04/24/2021
Last Update Date	:	04/24/2021

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