Provider Demographics
NPI:1346845351
Name:BUI, JESSICA THUY TIEN (RPH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:THUY TIEN
Last Name:BUI
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 1:223 W TIMBERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2017
Mailing Address - Country:US
Mailing Address - Phone:817-673-5419
Mailing Address - Fax:
Practice Address - Street 1:4580 BUFFALO GAP RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2704
Practice Address - Country:US
Practice Address - Phone:325-698-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist