Provider Demographics
NPI:1780991273
Name:THORNHILL, JARED
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:THORNHILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 COUNTY ROAD 6230
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-1537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8220 COUNTY ROAD 6230
Practice Address - Street 2:
Practice Address - City:SHALLOWATER
Practice Address - State:TX
Practice Address - Zip Code:79363-1537
Practice Address - Country:US
Practice Address - Phone:806-792-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist