Provider Demographics
NPI:1295047785
Name:BUSBY-TICE, PAMELA
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:BUSBY-TICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:BUSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14710 ASHLEY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4691
Mailing Address - Country:US
Mailing Address - Phone:713-775-9216
Mailing Address - Fax:
Practice Address - Street 1:12680 W LAKE HOUSTON PKWY # 8
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6087
Practice Address - Country:US
Practice Address - Phone:281-436-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist