Provider Demographics
NPI:1659979078
Name:CHERIAN, TINA TERESA (PHARM D)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:TERESA
Last Name:CHERIAN
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 1:341 S LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3309
Mailing Address - Country:US
Mailing Address - Phone:936-270-1027
Mailing Address - Fax:936-270-1030
Practice Address - Street 1:341 S LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3309
Practice Address - Country:US
Practice Address - Phone:936-270-1027
Practice Address - Fax:936-270-1030
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX546941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist