Provider Demographics
NPI:1366225518
Name:VU, JACEY M
Entity type:Individual
Prefix:MISS
First Name:JACEY
Middle Name:M
Last Name:VU
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 1:6721 PALMDALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2670
Mailing Address - Country:US
Mailing Address - Phone:682-234-5816
Mailing Address - Fax:
Practice Address - Street 1:4100 DALE EARNHARDT WAY STE 200
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-2389
Practice Address - Country:US
Practice Address - Phone:817-859-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist