Provider Demographics
NPI:1043591241
Name:TAKYI, JERLINE SHUNTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERLINE
Middle Name:SHUNTE
Last Name:TAKYI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 E PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3936
Mailing Address - Country:US
Mailing Address - Phone:469-297-5022
Mailing Address - Fax:469-297-5036
Practice Address - Street 1:424 E PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3936
Practice Address - Country:US
Practice Address - Phone:469-297-5022
Practice Address - Fax:469-297-5036
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist