MEDICARE: DR. JEFF D LITICKER PHARMD, 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	1835X0200X	Oncology Pharmacist	32049	TX

General Provider Information

NPI Number	:	1619247483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFF D LITICKER PHARMD, R.PH

Provider Business Mailing Address
First Line	:	2201 INWOOD RD
Second Line	:	NC2.852
City	:	DALLAS
State	:	TX
Zip	:	75235-7320
Country	:	US
Telephone Number	:	214-645-2681
Fax Number	:	214-645-2673

Provider Business Practice Location Address
First Line	:	2201 INWOOD RD
Second Line	:	NC2.852
City	:	DALLAS
State	:	TX
Zip	:	75235-7320
Country	:	US
Telephone Number	:	214-645-2681
Fax Number	:	214-645-2673

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

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	01/10/2012

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