Provider Demographics
NPI:1780796813
Name:HOUSE, TRESA RAY (RPH)
Entity type:Individual
Prefix:MS
First Name:TRESA
Middle Name:RAY
Last Name:HOUSE
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:PO BOX 102
Mailing Address - Street 2:201 PERKINS LANDING CIRCLE
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-0102
Mailing Address - Country:US
Mailing Address - Phone:205-669-1016
Mailing Address - Fax:
Practice Address - Street 1:208 PIERSON AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042-2918
Practice Address - Country:US
Practice Address - Phone:205-926-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist