Provider Demographics
NPI:1710387527
Name:QUALLIS, TINA-SHAI (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:TINA-SHAI
Middle Name:
Last Name:QUALLIS
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 1:509 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4218
Mailing Address - Country:US
Mailing Address - Phone:804-380-1138
Mailing Address - Fax:
Practice Address - Street 1:1101 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3824
Practice Address - Country:US
Practice Address - Phone:757-588-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist