Provider Demographics
NPI:1053790378
Name:HALL-GOMES, JO A (PHARM D)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:A
Last Name:HALL-GOMES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2205 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3789
Mailing Address - Country:US
Mailing Address - Phone:214-704-6859
Mailing Address - Fax:
Practice Address - Street 1:2205 LEXINGTON DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3789
Practice Address - Country:US
Practice Address - Phone:214-704-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32258183500000X
LA14002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist