Provider Demographics
NPI:1255926333
Name:JIA, DAISY (RPH)
Entity type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:JIA
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 1:4489 COUNTY ROAD 94
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3078
Mailing Address - Country:US
Mailing Address - Phone:281-692-9728
Mailing Address - Fax:
Practice Address - Street 1:4489 COUNTY ROAD 94
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3078
Practice Address - Country:US
Practice Address - Phone:281-692-9728
Practice Address - Fax:281-547-7331
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist