Provider Demographics
NPI:1053322602
Name:JEN-RX INC
Entity Type:Organization
Organization Name:JEN-RX INC
Other - Org Name:JEN CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:817-838-5544
Mailing Address - Street 1:3183 DENTON HWY
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76117
Mailing Address - Country:US
Mailing Address - Phone:817-838-5544
Mailing Address - Fax:817-838-5558
Practice Address - Street 1:3183 DENTON HWY
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117
Practice Address - Country:US
Practice Address - Phone:817-838-5544
Practice Address - Fax:817-838-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX176083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143931Medicaid
2098075OtherPK
1189080001Medicare NSC