Provider Demographics
NPI:1962007583
Name:CHI, JACQUELINE EYAH
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:EYAH
Last Name:CHI
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 1:6900 GRAND MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5404
Mailing Address - Country:US
Mailing Address - Phone:281-239-6517
Mailing Address - Fax:281-239-8065
Practice Address - Street 1:6900 GRAND MISSION BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5404
Practice Address - Country:US
Practice Address - Phone:281-239-6517
Practice Address - Fax:281-239-8065
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist