=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932758612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI JOBE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2019
-----------------------------------------------------
Last Update Date | 09/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1206 FANNIN ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78934-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-732-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1085 SHIRLEY OAKS ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78934-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-758-4705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 48747
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------