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General NPI Number Information
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NPI Number | 1679877435
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Entity Type | Organization
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Legal Business Name | MCJELE VENTURES, INC.
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 1021 S COLLEGIATE DR
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City | PARIS
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State | TX
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Zip | 75460-6309
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Country | US
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Telephone | 903-905-4961
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 S COLLEGIATE DR
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City | PARIS
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State | TX
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Zip | 75460-6309
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Country | US
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Telephone | 903-905-4961
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST-IN-CHARGE
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Name | DR. IMEINE A. UKHUN
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Credential | PHARM.D.
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Telephone | 903-905-4961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 27310
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License Number State | TX
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