Provider Demographics
NPI:1336793538
Name:PEPPER, JIM TOM (RPH)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:TOM
Last Name:PEPPER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 DOGWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065
Mailing Address - Country:US
Mailing Address - Phone:806-665-7642
Mailing Address - Fax:806-665-7226
Practice Address - Street 1:1420 N HOBART ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-4124
Practice Address - Country:US
Practice Address - Phone:806-665-7642
Practice Address - Fax:806-665-7226
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist