Healthcare Provider Details

I. General information

NPI: 1588323075
Provider Name (Legal Business Name): ASHHELEY JACOB VIYOUH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2021
Last Update Date: 12/11/2021
Certification Date: 12/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OLD SPANISH TRL
HOUSTON TX
77021-1328
US

IV. Provider business mailing address

3811 OLD SPANISH TRL
HOUSTON TX
77021-1328
US

V. Phone/Fax

Practice location:
  • Phone: 713-741-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69764
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: