Provider Demographics
NPI:1124630330
Name:JACK, KAYRAH (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:KAYRAH
Middle Name:
Last Name:JACK
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 DAWN RIVER CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7161
Mailing Address - Country:US
Mailing Address - Phone:832-740-9241
Mailing Address - Fax:
Practice Address - Street 1:2720 FM 1463 RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3827
Practice Address - Country:US
Practice Address - Phone:281-769-9255
Practice Address - Fax:281-769-9164
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist