Provider Demographics
NPI:1386911675
Name:SHAIA, THERESA MARIE
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:SHAIA
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 1:5419 GULFTON STREET LOFT B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081
Mailing Address - Country:US
Mailing Address - Phone:832-443-2898
Mailing Address - Fax:
Practice Address - Street 1:4323 SAN FELIPE ST
Practice Address - Street 2:T-0955
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3406
Practice Address - Country:US
Practice Address - Phone:713-331-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist