Healthcare Provider Details

I. General information

NPI: 1346628914
Provider Name (Legal Business Name): JON ALBRECHT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE DEPARTMENT OF PHARMACY
DALLAS TX
75203-1201
US

IV. Provider business mailing address

1441 N BECKLEY AVE DEPARTMENT OF PHARMACY
DALLAS TX
75203-1201
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-2416
  • Fax: 214-947-2402
Mailing address:
  • Phone: 214-947-2416
  • Fax: 214-947-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number28503
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number28503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: