Provider Demographics
NPI:1518568997
Name:PLUNKETT, JEFFREY WARREN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WARREN
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 STONES THROW AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0331
Mailing Address - Country:US
Mailing Address - Phone:936-328-6718
Mailing Address - Fax:
Practice Address - Street 1:1620 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9008
Practice Address - Country:US
Practice Address - Phone:936-327-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist