Provider Demographics
NPI:1154659753
Name:WITT, JEAN ANN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:WITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26731 US HIGHWAY 380 E
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8210
Mailing Address - Country:US
Mailing Address - Phone:972-347-5112
Mailing Address - Fax:
Practice Address - Street 1:26731 US HIGHWAY 380 E
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-8210
Practice Address - Country:US
Practice Address - Phone:972-347-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist