Provider Demographics
NPI:1306440300
Name:ABRAHAM, JAIMY (RPH)
Entity type:Individual
Prefix:
First Name:JAIMY
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5809
Mailing Address - Country:US
Mailing Address - Phone:972-722-2040
Mailing Address - Fax:
Practice Address - Street 1:4282 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-5809
Practice Address - Country:US
Practice Address - Phone:972-722-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist