MEDICARE: DR. TANAYA L KIZZINE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	41073	TX

General Provider Information

NPI Number	:	1568206167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANAYA L KIZZINE PHARMD

Provider Business Mailing Address
First Line	:	7327 WOODED LAKE LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-7832
Country	:	US
Telephone Number	:	281-716-5846
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 OLD KATY RD STE 1062
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2128
Country	:	US
Telephone Number	:	833-234-6836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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