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NPI Code Detail

MEDICARE: FLORA JEAN TISDALE

MEDICARE: FLORA JEAN TISDALE
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
1183500000XPharmacist19077TX

General Provider Information

NPI Number : 1851629216
Entity Type Code : Individual
Provider Name (Legal Business Name) : FLORA JEAN TISDALE
Provider Business Mailing Address
First Line : 5280 BUFFALO SPEEDWAY
Second Line :
City : HOUSTON
State : TX
Zip : 77005-4204
Country : US
Telephone Number : 713-838-7704
Fax Number :
Provider Business Practice Location Address
First Line : 5280 BUFFALO SPEEDWAY
Second Line :
City : HOUSTON
State : TX
Zip : 77005-4204
Country : US
Telephone Number : 713-838-7704
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2009
Last Update Date : 11/24/2009

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Directions to “ FLORA JEAN TISDALE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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