Provider Demographics
NPI:1598386195
Name:MULLIS, JENNIFER
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MULLIS
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 1:102A SAN BERNARD
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422
Mailing Address - Country:US
Mailing Address - Phone:979-798-4800
Mailing Address - Fax:979-798-4803
Practice Address - Street 1:102 SAN BERNARD ST
Practice Address - Street 2:SUITE A
Practice Address - City:BRAZORIA
Practice Address - State:TX
Practice Address - Zip Code:77422
Practice Address - Country:US
Practice Address - Phone:979-798-4800
Practice Address - Fax:979-798-4803
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist