Provider Demographics
NPI:1235740044
Name:BADON, TISHARA VALENCIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TISHARA
Middle Name:VALENCIA
Last Name:BADON
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 1:8088 PARK LN APT 1113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5981
Mailing Address - Country:US
Mailing Address - Phone:504-715-7794
Mailing Address - Fax:
Practice Address - Street 1:11661 PRESTON RD STE 218
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6173
Practice Address - Country:US
Practice Address - Phone:214-363-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist