Provider Demographics
NPI:1659612976
Name:CORREA, JAYNE V (RPH)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:V
Last Name:CORREA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21840 PARK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2748
Mailing Address - Country:US
Mailing Address - Phone:210-573-6230
Mailing Address - Fax:
Practice Address - Street 1:20725 STATE HIGHWAY 46 W
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6270
Practice Address - Country:US
Practice Address - Phone:830-438-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist