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 1:6517 SAINT JOHNS DR APT 1042
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2789
Mailing Address - Country:US
Mailing Address - Phone:682-234-5816
Mailing Address - Fax:
Practice Address - Street 1:6517 SAINT JOHNS DR APT 1042
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-2789
Practice Address - Country:US
Practice Address - Phone:682-234-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist