Provider Demographics
NPI:1407984990
Name:WILLIS, JAMESIA DEANNA
Entity Type:Individual
Prefix:MS
First Name:JAMESIA
Middle Name:DEANNA
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 HILLCROFT ST
Mailing Address - Street 2:SUITE-101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3006
Mailing Address - Country:US
Mailing Address - Phone:713-776-0806
Mailing Address - Fax:713-776-0189
Practice Address - Street 1:6300 HILLCROFT ST
Practice Address - Street 2:SUITE-101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3006
Practice Address - Country:US
Practice Address - Phone:713-776-0806
Practice Address - Fax:713-776-0189
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist