Provider Demographics
NPI:1942060306
Name:BLEVINS, TIA MAROSSI (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:MAROSSI
Last Name:BLEVINS
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 1:226 MCCLELLAN TRL
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-0656
Mailing Address - Country:US
Mailing Address - Phone:919-914-2631
Mailing Address - Fax:
Practice Address - Street 1:1718 FORDHAM BLVD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5808
Practice Address - Country:US
Practice Address - Phone:919-942-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist