Provider Demographics
NPI:1285018259
Name:POIROT, JACKIE (RPH)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:POIROT
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 1:2603 OAK LAWN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4021
Mailing Address - Country:US
Mailing Address - Phone:214-252-1984
Mailing Address - Fax:
Practice Address - Street 1:2603 OAK LAWN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4021
Practice Address - Country:US
Practice Address - Phone:214-252-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279811835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support