Provider Demographics
NPI:1154550044
Name:MCCREA, TYREESE MARVA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYREESE
Middle Name:MARVA
Last Name:MCCREA
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 1:1713 S BROAD ST
Mailing Address - Street 2:PO BOX 54490
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1527
Mailing Address - Country:US
Mailing Address - Phone:866-401-0432
Mailing Address - Fax:
Practice Address - Street 1:1713 S BROAD ST
Practice Address - Street 2:BOX 54490
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1527
Practice Address - Country:US
Practice Address - Phone:866-401-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist