Provider Demographics
NPI:1275871568
Name:PAPAK, JEFFREY JOHN (CPHT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:PAPAK
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301
Mailing Address - Country:US
Mailing Address - Phone:940-322-8626
Mailing Address - Fax:940-322-8476
Practice Address - Street 1:1610 9TH STREET
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301
Practice Address - Country:US
Practice Address - Phone:940-322-8626
Practice Address - Fax:940-322-8476
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126287183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician