MEDICARE: THERESA MARIE SHAIA

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	39303	TX

General Provider Information

NPI Number	:	1386911675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MARIE SHAIA

Provider Business Mailing Address
First Line	:	5419 GULFTON STREET LOFT B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081
Country	:	US
Telephone Number	:	832-443-2898
Fax Number	:

Provider Business Practice Location Address
First Line	:	4323 SAN FELIPE ST
Second Line	:	T-0955
City	:	HOUSTON
State	:	TX
Zip	:	77027-3406
Country	:	US
Telephone Number	:	713-331-0166
Fax Number	:

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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Directions to “ THERESA MARIE SHAIA ” Practice Location

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