Provider Demographics
NPI:1326684481
Name:DAVENPORT, JESSICA (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
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:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:SPLENDORA
Mailing Address - State:TX
Mailing Address - Zip Code:77372-1081
Mailing Address - Country:US
Mailing Address - Phone:713-899-4082
Mailing Address - Fax:
Practice Address - Street 1:81 COUNTY ROAD 5043
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-7732
Practice Address - Country:US
Practice Address - Phone:713-899-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103897183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician