Provider Demographics
NPI:1730580416
Name:HEAD, JONATHAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:HEAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8292 FM 455 W
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-2634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6420 N MACARTHUR BLVD
Practice Address - Street 2:100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2837
Practice Address - Country:US
Practice Address - Phone:972-580-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist