MEDICARE: MARIA YVONNE TIENDA RPH

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	49889	TX

General Provider Information

NPI Number	:	1467739995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA YVONNE TIENDA RPH

Provider Business Mailing Address
First Line	:	7014 FM 78
Second Line	:	T-2452
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1758
Country	:	US
Telephone Number	:	210-424-3005
Fax Number	:	210-424-3015

Provider Business Practice Location Address
First Line	:	7014 FM 78
Second Line	:	T-2452
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1758
Country	:	US
Telephone Number	:	210-424-3005
Fax Number	:	210-424-3015

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

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

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