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General NPI Number Information
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NPI Number | 1356337117
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Entity Type | Organization
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Legal Business Name | JESPERSEN FAMILY DRUG INC.
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 302 NORTH MAIN STREET
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City | DUNCANVILLE
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State | TX
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Zip | 75116-3651
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Country | US
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Telephone | 972-298-4936
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Fax | 972-296-9844
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Provider Business Mailing Address
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Address Line | 302 N MAIN ST
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City | DUNCANVILLE
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State | TX
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Zip | 75116-3651
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Country | US
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Telephone | 972-298-4936
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Fax | 972-296-9844
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. DAN JESPERSEN
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Credential | RPH
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Telephone | 972-298-4936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 11685
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11685
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License Number State | TX
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