Provider Demographics
NPI:1558943092
Name:JAEGERS, ARLENE BULAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:BULAN
Last Name:JAEGERS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 WHITE SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4412
Mailing Address - Country:US
Mailing Address - Phone:817-246-2411
Mailing Address - Fax:817-246-2621
Practice Address - Street 1:9620 WHITE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4412
Practice Address - Country:US
Practice Address - Phone:817-246-2411
Practice Address - Fax:817-246-2621
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist