Provider Demographics
NPI:1578178299
Name:SCALIA, JENNIFER LARAY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LARAY
Last Name:SCALIA
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:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GAP
Mailing Address - State:TX
Mailing Address - Zip Code:79508-0836
Mailing Address - Country:US
Mailing Address - Phone:325-280-6812
Mailing Address - Fax:
Practice Address - Street 1:4450 BUFFALO GAP RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2703
Practice Address - Country:US
Practice Address - Phone:325-695-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36767OtherTEXAS PHARMACY LICENSE