Provider Demographics
NPI:1992468383
Name:MCBEAN, JELICE MICHELLE
Entity Type:Individual
Prefix:
First Name:JELICE
Middle Name:MICHELLE
Last Name:MCBEAN
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 1:17602 EMERALD GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3954
Mailing Address - Country:US
Mailing Address - Phone:832-212-5207
Mailing Address - Fax:
Practice Address - Street 1:2800 NORTH LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8838
Practice Address - Country:US
Practice Address - Phone:281-727-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist