Provider Demographics
NPI:1447617154
Name:MONTIJO, JANE LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
Last Name:MONTIJO
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 1:3460 DAISY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8050
Mailing Address - Country:US
Mailing Address - Phone:972-900-1434
Mailing Address - Fax:
Practice Address - Street 1:8840 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7593
Practice Address - Country:US
Practice Address - Phone:800-447-7558
Practice Address - Fax:855-838-0623
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist