Provider Demographics
NPI:1164894507
Name:JVN CREATIVE CARE INC
Entity Type:Organization
Organization Name:JVN CREATIVE CARE INC
Other - Org Name:SEALY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-256-3045
Mailing Address - Street 1:707 MEYER ST
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-2715
Mailing Address - Country:US
Mailing Address - Phone:979-256-3045
Mailing Address - Fax:979-256-3101
Practice Address - Street 1:707 MEYER ST
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-2715
Practice Address - Country:US
Practice Address - Phone:979-256-3045
Practice Address - Fax:979-256-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154839OtherPK