Provider Demographics
NPI:1811408263
Name:PHILIPOSE, JINU (PHARM D)
Entity Type:Individual
Prefix:
First Name:JINU
Middle Name:
Last Name:PHILIPOSE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 HEADQUARTERS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5965
Mailing Address - Country:US
Mailing Address - Phone:469-362-3740
Mailing Address - Fax:469-362-3740
Practice Address - Street 1:6565 HEADQUARTERS DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5965
Practice Address - Country:US
Practice Address - Phone:469-362-3740
Practice Address - Fax:469-362-3740
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist