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General NPI Number Information
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NPI Number | 1124630330
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Entity Type | Individual
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Provider Name | KAYRAH JACK PHARM D., RPH
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Gender | Female
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 2720 FM 1463 RD
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City | KATY
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State | TX
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Zip | 77494-3827
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Country | US
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Telephone | 281-769-9255
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Fax | 281-769-9164
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Provider Business Mailing Address
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Address Line | 10910 DAWN RIVER CT
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City | CYPRESS
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State | TX
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Zip | 77433-7161
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Country | US
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Telephone | 832-740-9241
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 58787
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License Number State | TX
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