Provider Demographics
NPI:1215525993
Name:CHI, TINA X (PHARMACIST)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:X
Last Name:CHI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15642 SAND CANYON AVE UNIT 51118
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-5242
Mailing Address - Country:US
Mailing Address - Phone:949-378-6908
Mailing Address - Fax:
Practice Address - Street 1:15180 KENSINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1801
Practice Address - Country:US
Practice Address - Phone:714-259-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist