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NPI Code Detail

MEDICARE: JENNIFER RA PHARM.D

MEDICARE: JENNIFER RA 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
1183500000XPharmacist72007TX

General Provider Information

NPI Number : 1588359509
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RA PHARM.D
Provider Business Mailing Address
First Line : 1202 RICE AVE
Second Line :
City : CEDAR PARK
State : TX
Zip : 78613-6841
Country : US
Telephone Number : 469-343-3358
Fax Number :
Provider Business Practice Location Address
First Line : 799 LOUIS HENNA BLVD
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-7074
Country : US
Telephone Number : 512-310-7678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2023
Last Update Date : 04/06/2023

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