Individual
JACOB SCIVALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 N WASHINGTON AVE, DALLAS, TX 75246-1754
(254) 202-1272
(469) 800-8335
Mailing address
1400 ANDREWS PKWY APT 2124, ALLEN, TX 75002-2961
(469) 268-0635
(469) 800-8335
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
200639
TX
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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