Healthcare Provider Details

I. General information

NPI: 1275871568
Provider Name (Legal Business Name): JEFFREY JOHN PAPAK CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 9TH STREET
WICHITA FALLS TX
76301
US

IV. Provider business mailing address

1610 9TH STREET
WICHITA FALLS TX
76301
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-8626
  • Fax: 940-322-8476
Mailing address:
  • Phone: 940-322-8626
  • Fax: 940-322-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number126287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: