Healthcare Provider Details

I. General information

NPI: 1619788833
Provider Name (Legal Business Name): PHINEY TREESA PHILIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12225 HIGHWAY 6
FRESNO TX
77545-8805
US

IV. Provider business mailing address

6303 SIENNA RANCH RD APT 2111
MISSOURI CITY TX
77459-4787
US

V. Phone/Fax

Practice location:
  • Phone: 281-431-4248
  • Fax:
Mailing address:
  • Phone: 346-347-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number371293
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: