Provider Demographics
NPI:1962048587
Name:PROFFIT, JAELIN (RPH)
Entity type:Individual
Prefix:
First Name:JAELIN
Middle Name:
Last Name:PROFFIT
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 1:1000 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3565
Mailing Address - Country:US
Mailing Address - Phone:830-896-7440
Mailing Address - Fax:830-896-2221
Practice Address - Street 1:1000 MAIN ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3565
Practice Address - Country:US
Practice Address - Phone:830-896-7440
Practice Address - Fax:830-896-2221
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist