Provider Demographics
NPI:1750004008
Name:KIZITO, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:KIZITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WALNUT COVE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8162
Mailing Address - Country:US
Mailing Address - Phone:281-841-3937
Mailing Address - Fax:
Practice Address - Street 1:980 CLEAR LAKE CITY BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-6604
Practice Address - Country:US
Practice Address - Phone:281-480-4410
Practice Address - Fax:281-480-4413
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist