Provider Demographics
NPI:1164687802
Name:DADE, REBA S (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBA
Middle Name:S
Last Name:DADE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15107 MOUNTAIN HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-1258
Mailing Address - Country:US
Mailing Address - Phone:832-524-9977
Mailing Address - Fax:
Practice Address - Street 1:15107 MOUNTAIN HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-1258
Practice Address - Country:US
Practice Address - Phone:832-524-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist