Provider Demographics
NPI:1215533575
Name:FAIN, JEFFREY DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:FAIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JD
Other - Middle Name:
Other - Last Name:FAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS PHARM, PHARMD
Mailing Address - Street 1:233 S MANSE AVE
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-3440
Mailing Address - Country:US
Mailing Address - Phone:979-540-8926
Mailing Address - Fax:979-542-3489
Practice Address - Street 1:233 S MANSE AVE
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-3440
Practice Address - Country:US
Practice Address - Phone:979-542-3164
Practice Address - Fax:979-542-3489
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302281835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX264756OtherLICENSE TX 30228