Provider Demographics
NPI:1013291608
Name:BECKER, TISCHA (PHARMD, PHC, RPH)
Entity Type:Individual
Prefix:DR
First Name:TISCHA
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:PHARMD, PHC, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BASSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PARAJE
Mailing Address - State:NM
Mailing Address - Zip Code:87007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 BASSWOOD RD
Practice Address - Street 2:
Practice Address - City:PARAJE
Practice Address - State:NM
Practice Address - Zip Code:87007
Practice Address - Country:US
Practice Address - Phone:505-552-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000072951835P0018X
NMPC000001901835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist