Provider Demographics
NPI:1568206167
Name:KIZZINE, TANAYA L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TANAYA
Middle Name:L
Last Name:KIZZINE
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 1:7327 WOODED LAKE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7832
Mailing Address - Country:US
Mailing Address - Phone:281-716-5846
Mailing Address - Fax:
Practice Address - Street 1:7055 OLD KATY RD STE 1062
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2128
Practice Address - Country:US
Practice Address - Phone:833-234-6836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist