Provider Demographics
NPI:1659009652
Name:RAMOS, JACKLYN NICOLE
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:NICOLE
Last Name:RAMOS
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 1:910 KITTY HAWK RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3806
Mailing Address - Country:US
Mailing Address - Phone:210-942-2120
Mailing Address - Fax:
Practice Address - Street 1:910 KITTY HAWK RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3806
Practice Address - Country:US
Practice Address - Phone:210-942-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291339183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician