Provider Demographics
NPI:1952901134
Name:RAGSDALE, JENNIFER JEANEAN (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEANEAN
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BLANK
Other - Last Name:RAGSDALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:321 LEISUREWOODS DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2422
Mailing Address - Country:US
Mailing Address - Phone:512-848-0913
Mailing Address - Fax:512-295-5034
Practice Address - Street 1:1904 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-3949
Practice Address - Country:US
Practice Address - Phone:512-398-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist