Provider Demographics
NPI:1427367739
Name:TINSON, KADESHA LAWANN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KADESHA
Middle Name:LAWANN
Last Name:TINSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 S 44TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-4021
Mailing Address - Country:US
Mailing Address - Phone:602-437-1826
Mailing Address - Fax:
Practice Address - Street 1:1100 E MCDOWELL RD
Practice Address - Street 2:PHAMACY DEPT.
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2611
Practice Address - Country:US
Practice Address - Phone:602-839-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist