=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003635236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIGIT JOSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2024
-----------------------------------------------------
Last Update Date | 10/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3410 GULF FWY
-----------------------------------------------------
City | DICKINSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77539-4119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-337-7751
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1504 MORELAND PARK CT
-----------------------------------------------------
City | FRIENDSWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77546-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 6089
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------