Provider Demographics
NPI:1003127440
Name:COUNCIL, JACK L (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:L
Last Name:COUNCIL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 N SHARY RD
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-3241
Mailing Address - Country:US
Mailing Address - Phone:956-585-7743
Mailing Address - Fax:956-584-5759
Practice Address - Street 1:2301 N SHARY RD
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-3241
Practice Address - Country:US
Practice Address - Phone:956-585-7743
Practice Address - Fax:956-584-5759
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX042262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist