Provider Demographics
NPI:1710576236
Name:FAISON, TINASHA KIMIKO (RPHT)
Entity Type:Individual
Prefix:
First Name:TINASHA
Middle Name:KIMIKO
Last Name:FAISON
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W STAN SCHLUETER LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5079
Mailing Address - Country:US
Mailing Address - Phone:254-519-2760
Mailing Address - Fax:866-604-0356
Practice Address - Street 1:1101 W STAN SCHLUETER LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5079
Practice Address - Country:US
Practice Address - Phone:254-519-2760
Practice Address - Fax:866-604-0356
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252869183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician