Provider Demographics
NPI:1265036685
Name:STAAB, JAN ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:ELIZABETH
Last Name:STAAB
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 1:2220 CROSS TIMBERS RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2615
Mailing Address - Country:US
Mailing Address - Phone:972-874-1040
Mailing Address - Fax:
Practice Address - Street 1:2220 CROSS TIMBERS RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2615
Practice Address - Country:US
Practice Address - Phone:972-874-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist