MEDICARE: JODI CASE

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	42511	TX

General Provider Information

NPI Number	:	1487253811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI CASE

Provider Business Mailing Address
First Line	:	3410 GULF FWY
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-4119
Country	:	US
Telephone Number	:	281-337-7751
Fax Number	:	281-337-7786

Provider Business Practice Location Address
First Line	:	3410 GULF FWY
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-4119
Country	:	US
Telephone Number	:	281-337-7751
Fax Number	:	281-337-7786

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

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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Directions to “ JODI CASE ” Practice Location

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