Healthcare Provider Details

I. General information

NPI: 1922697440
Provider Name (Legal Business Name): JESSICA DENNY CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7988 FM 1488 RD
MAGNOLIA TX
77354-1611
US

IV. Provider business mailing address

7988 FM 1488 RD
MAGNOLIA TX
77354-1611
US

V. Phone/Fax

Practice location:
  • Phone: 281-252-0069
  • Fax: 866-760-5923
Mailing address:
  • Phone: 281-252-0069
  • Fax: 866-760-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number202417
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: