Provider Demographics
NPI:1942655972
Name:ABRAHAM, JAIMSON
Entity Type:Individual
Prefix:
First Name:JAIMSON
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 HILLCROFT ST STE 109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1005
Mailing Address - Country:US
Mailing Address - Phone:713-270-7771
Mailing Address - Fax:713-988-3227
Practice Address - Street 1:6065 HILLCROFT ST STE 109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1005
Practice Address - Country:US
Practice Address - Phone:713-270-7771
Practice Address - Fax:713-988-3227
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist