Provider Demographics
NPI:1902340946
Name:PHILIP, JAYA (R PH)
Entity Type:Individual
Prefix:MRS
First Name:JAYA
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7904 NE LOOP 820
Mailing Address - Street 2:SUITE A & B,
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7395
Mailing Address - Country:US
Mailing Address - Phone:855-362-7878
Mailing Address - Fax:
Practice Address - Street 1:7904 NE LOOP 820
Practice Address - Street 2:SUITE A & B
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7395
Practice Address - Country:US
Practice Address - Phone:855-362-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541781835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care