Provider Demographics
NPI:1104165257
Name:SMALL, PAULA TRINCHELL (PHARMD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:TRINCHELL
Last Name:SMALL
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 1:4417 S LANCASTER RD STE 2265
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7173
Mailing Address - Country:US
Mailing Address - Phone:214-413-3726
Mailing Address - Fax:214-857-5564
Practice Address - Street 1:4417 S LANCASTER RD STE 2265
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7173
Practice Address - Country:US
Practice Address - Phone:214-413-3726
Practice Address - Fax:214-857-5564
Is Sole Proprietor?:No
Enumeration Date:2013-02-10
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE010062183500000X
TX52768183500000X, 1835P0018X
VA0202215413183500000X, 1835P0018X
MSE-0100621835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist