Provider Demographics
NPI:1013561075
Name:PAINTSIL, IRENE GYETUAH
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:GYETUAH
Last Name:PAINTSIL
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 1:3417 N MIDLAND DR APT 1107
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4614
Mailing Address - Country:US
Mailing Address - Phone:508-762-8396
Mailing Address - Fax:
Practice Address - Street 1:1500 TRADEWINDS BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2833
Practice Address - Country:US
Practice Address - Phone:432-253-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist