MEDICARE: KEI'CHARA FLEEKS-JONES CPHT

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	183700000X	Pharmacy Technician	230364	TX

General Provider Information

NPI Number	:	1609456052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEI'CHARA FLEEKS-JONES CPHT

Provider Business Mailing Address
First Line	:	10300 KATY FWY APT 403
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-5134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 KATY FWY APT 403
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-5134
Country	:	US
Telephone Number	:	832-330-1128
Fax Number	:

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

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	04/09/2021

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