Provider Demographics
NPI:1134569742
Name:DOUGLAS, TINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:DOUGLAS
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 1:6730 FOREST MEWS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-1561
Mailing Address - Country:US
Mailing Address - Phone:713-201-8639
Mailing Address - Fax:
Practice Address - Street 1:6730 FOREST MEWS CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-1561
Practice Address - Country:US
Practice Address - Phone:713-201-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298681835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy