Provider Demographics
NPI:1407183387
Name:GORLE, JAIRAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAIRAM
Middle Name:
Last Name:GORLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14805 HOLLY TREE LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0176
Mailing Address - Country:US
Mailing Address - Phone:832-439-5325
Mailing Address - Fax:972-329-8275
Practice Address - Street 1:1000 N PRESTON RD STE 10
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8890
Practice Address - Country:US
Practice Address - Phone:214-338-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46979183500000X
MI5302035504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist