Provider Demographics
NPI:1912527441
Name:HOWARD, MARINDA RAE
Entity Type:Individual
Prefix:
First Name:MARINDA
Middle Name:RAE
Last Name:HOWARD
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 1:18451 DALLAS PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5202
Mailing Address - Country:US
Mailing Address - Phone:833-885-5812
Mailing Address - Fax:
Practice Address - Street 1:18451 DALLAS PKWY STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-5202
Practice Address - Country:US
Practice Address - Phone:833-885-5812
Practice Address - Fax:833-885-5813
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist