Provider Demographics
NPI:1932753894
Name:NIEMTSCHK, JANE SPAGNOLETTI
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:SPAGNOLETTI
Last Name:NIEMTSCHK
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 1:416 VISTA TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8343
Mailing Address - Country:US
Mailing Address - Phone:972-315-9593
Mailing Address - Fax:
Practice Address - Street 1:750 WEST JOHN CARPENTER FREEWAY
Practice Address - Street 2:MC500
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039
Practice Address - Country:US
Practice Address - Phone:469-524-4820
Practice Address - Fax:469-524-7163
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist