=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780796813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRESA RAY HOUSE RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 PIERSON AVE
-----------------------------------------------------
City | CENTREVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35042-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-926-3277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 102 201 PERKINS LANDING CIRCLE
-----------------------------------------------------
City | COLUMBIANA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35051-0102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-669-1016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 11807
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------