Provider Demographics
NPI:1205436714
Name:VAN SCHOIK, JACKIE (RPH)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:VAN SCHOIK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 SUN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3535
Mailing Address - Country:US
Mailing Address - Phone:254-340-6601
Mailing Address - Fax:254-340-6612
Practice Address - Street 1:733 SUN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3535
Practice Address - Country:US
Practice Address - Phone:254-340-6601
Practice Address - Fax:254-340-6612
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist