Provider Demographics
NPI:1467822775
Name:SURLES, RENATA (PHARMD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:SURLES
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 1:1836 W DAVIS ST APT 1206
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5423
Mailing Address - Country:US
Mailing Address - Phone:504-250-6645
Mailing Address - Fax:
Practice Address - Street 1:1836 W DAVIS ST APT 1206
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5423
Practice Address - Country:US
Practice Address - Phone:504-250-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist