Provider Demographics
NPI:1770042772
Name:TENII, ISSIFU
Entity Type:Individual
Prefix:
First Name:ISSIFU
Middle Name:
Last Name:TENII
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11203 LAKE JUNE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-1219
Mailing Address - Country:US
Mailing Address - Phone:214-391-7441
Mailing Address - Fax:214-391-7443
Practice Address - Street 1:11203 LAKE JUNE RD STE 206
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-1219
Practice Address - Country:US
Practice Address - Phone:214-391-7441
Practice Address - Fax:214-391-7443
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy