Provider Demographics
NPI:1750664959
Name:SPEED, JERIANN WATSON
Entity Type:Individual
Prefix:MRS
First Name:JERIANN
Middle Name:WATSON
Last Name:SPEED
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 1:600 W ARBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3702
Mailing Address - Country:US
Mailing Address - Phone:817-417-1602
Mailing Address - Fax:
Practice Address - Street 1:600 W ARBROOK BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3702
Practice Address - Country:US
Practice Address - Phone:817-417-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist