Provider Demographics
NPI:1467053363
Name:PACK, JEFFREY SPENCER (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SPENCER
Last Name:PACK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 E BUSINESS 190
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2584
Mailing Address - Country:US
Mailing Address - Phone:254-542-7697
Mailing Address - Fax:
Practice Address - Street 1:2720 E BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2584
Practice Address - Country:US
Practice Address - Phone:254-542-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist