Healthcare Provider Details

I. General information

NPI: 1023761467
Provider Name (Legal Business Name): TABITHA LYTLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 S PADRE ISLAND DR
CORPUS CHRISTI TX
78416-1398
US

IV. Provider business mailing address

1821 S PADRE ISLAND DR
CORPUS CHRISTI TX
78416-1398
US

V. Phone/Fax

Practice location:
  • Phone: 361-854-5804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: