Provider Demographics
NPI:1063094241
Name:RAYSOR, TIA BRIANA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIA
Middle Name:BRIANA
Last Name:RAYSOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PERRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32220-3746
Mailing Address - Country:US
Mailing Address - Phone:954-240-5157
Mailing Address - Fax:
Practice Address - Street 1:2101 SADLER RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA
Practice Address - State:FL
Practice Address - Zip Code:32034-4452
Practice Address - Country:US
Practice Address - Phone:904-277-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist