Provider Demographics
NPI:1215528609
Name:SOLIS, JESSICA DEE (CPHT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DEE
Last Name:SOLIS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1056
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-1056
Mailing Address - Country:US
Mailing Address - Phone:281-659-6748
Mailing Address - Fax:
Practice Address - Street 1:13401 I-10 EAST
Practice Address - Street 2:
Practice Address - City:MONT BELVIEU
Practice Address - State:TX
Practice Address - Zip Code:77523
Practice Address - Country:US
Practice Address - Phone:281-420-9300
Practice Address - Fax:281-576-3583
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112253183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112253OtherTEXAS STATE BOARD OF PHARMACY