Provider Demographics
NPI:1831458090
Name:SHIVERS, INGA M (RPH)
Entity Type:Individual
Prefix:MISS
First Name:INGA
Middle Name:M
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 GARDEN ISLE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-7703
Mailing Address - Country:US
Mailing Address - Phone:214-402-6275
Mailing Address - Fax:469-814-4141
Practice Address - Street 1:2228 GARDEN ISLE DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-7703
Practice Address - Country:US
Practice Address - Phone:214-402-6275
Practice Address - Fax:469-814-4141
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307341835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist