Provider Demographics
NPI:1366842551
Name:TENNEY, JUSTIN WADE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WADE
Last Name:TENNEY
Suffix:
Gender:M
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:SIDRA MEDICAL AND RESEARCH CENTER
Mailing Address - Street 2:
Mailing Address - City:DOHA
Mailing Address - State:DOHA
Mailing Address - Zip Code:26999
Mailing Address - Country:QA
Mailing Address - Phone:9743-378-9456
Mailing Address - Fax:
Practice Address - Street 1:SIDRA MEDICAL AND RESEARCH CENTER
Practice Address - Street 2:
Practice Address - City:DOHA
Practice Address - State:DOHA
Practice Address - Zip Code:26999
Practice Address - Country:QA
Practice Address - Phone:9743-378-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV185151835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist