Provider Demographics
NPI:1093240848
Name:TINAPA MEDICAL MANAGEMENT INC
Entity Type:Organization
Organization Name:TINAPA MEDICAL MANAGEMENT INC
Other - Org Name:MEADOWS COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-602-5049
Mailing Address - Street 1:12714 NORTH FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-1227
Mailing Address - Country:US
Mailing Address - Phone:832-602-5049
Mailing Address - Fax:281-872-4711
Practice Address - Street 1:12714 NORTH FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1227
Practice Address - Country:US
Practice Address - Phone:832-602-5049
Practice Address - Fax:281-872-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27627333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168719OtherPK