Provider Demographics
NPI:1801622121
Name:TYO, RISA D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RISA
Middle Name:D
Last Name:TYO
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 1:2701 OSLER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8351
Mailing Address - Country:US
Mailing Address - Phone:972-647-2721
Mailing Address - Fax:
Practice Address - Street 1:2701 OSLER DR STE 1
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8351
Practice Address - Country:US
Practice Address - Phone:972-647-2721
Practice Address - Fax:972-660-1239
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist