Provider Demographics
NPI:1063018174
Name:DANIEL, JENNIE R (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:R
Last Name:DANIEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 CYPRESS POINT DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2607
Mailing Address - Country:US
Mailing Address - Phone:832-226-2142
Mailing Address - Fax:
Practice Address - Street 1:2816 CYPRESS POINT DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2607
Practice Address - Country:US
Practice Address - Phone:832-226-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist