Provider Demographics
NPI:1144867979
Name:JOHN, JINI SUSAN (PHARM D)
Entity type:Individual
Prefix:
First Name:JINI
Middle Name:SUSAN
Last Name:JOHN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W BEND DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3473
Mailing Address - Country:US
Mailing Address - Phone:832-455-2106
Mailing Address - Fax:
Practice Address - Street 1:820 E MCCART ST
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-5634
Practice Address - Country:US
Practice Address - Phone:940-482-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist