Provider Demographics
NPI:1336408897
Name:TIRADO, MARY ALEXANDRA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALEXANDRA
Last Name:TIRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 RENNINGER RD
Mailing Address - Street 2:
Mailing Address - City:BECHTELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19505-9510
Mailing Address - Country:US
Mailing Address - Phone:610-334-8848
Mailing Address - Fax:
Practice Address - Street 1:1140 TOWN SQUARE RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-1017
Practice Address - Country:US
Practice Address - Phone:610-323-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPI112368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist