Provider Demographics
NPI:1679877435
Name:MCJELE VENTURES, INC.
Entity Type:Organization
Organization Name:MCJELE VENTURES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:IMEINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:UKHUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:903-905-4961
Mailing Address - Street 1:1021 S COLLEGIATE DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6309
Mailing Address - Country:US
Mailing Address - Phone:903-905-4961
Mailing Address - Fax:
Practice Address - Street 1:1021 S COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6309
Practice Address - Country:US
Practice Address - Phone:903-905-4961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27310261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center