Healthcare Provider Details

I. General information

NPI: 1407382914
Provider Name (Legal Business Name): ANJE MARI JUAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 19TH ST
LUBBOCK TX
79410-1203
US

IV. Provider business mailing address

3615 19TH ST
LUBBOCK TX
79410-1203
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-0407
  • Fax:
Mailing address:
  • Phone: 806-725-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58497
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: