MEDICARE: DAN WESLEY JESPERSEN R. PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20234	TX

General Provider Information

NPI Number	:	1376128959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN WESLEY JESPERSEN R. PH.

Provider Business Mailing Address
First Line	:	302 N MAIN ST
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-3651
Country	:	US
Telephone Number	:	972-298-4936
Fax Number	:	972-296-9844

Provider Business Practice Location Address
First Line	:	302 N MAIN ST
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-3651
Country	:	US
Telephone Number	:	972-298-4936
Fax Number	:	972-296-9844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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