Provider Demographics
NPI:1942349162
Name:TILTON, DANA SUE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:SUE
Last Name:TILTON
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 1:315 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPUR
Mailing Address - State:TX
Mailing Address - Zip Code:79370-2812
Mailing Address - Country:US
Mailing Address - Phone:806-271-3394
Mailing Address - Fax:806-271-3631
Practice Address - Street 1:315 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:SPUR
Practice Address - State:TX
Practice Address - Zip Code:79370
Practice Address - Country:US
Practice Address - Phone:806-271-3394
Practice Address - Fax:806-271-3631
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308943336L0003X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144501Medicaid
4532025OtherNABP
4532025OtherNABP