Provider Demographics
NPI:1801419692
Name:JOLANTO CORPORATION
Entity Type:Organization
Organization Name:JOLANTO CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:RPHD
Authorized Official - Phone:832-358-8500
Mailing Address - Street 1:10101 SOUTHWEST FWY STE 315
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1111
Mailing Address - Country:US
Mailing Address - Phone:832-358-8500
Mailing Address - Fax:832-358-8539
Practice Address - Street 1:10101 SOUTHWEST FWY STE 315
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1111
Practice Address - Country:US
Practice Address - Phone:832-358-8500
Practice Address - Fax:832-358-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146190Medicaid