Provider Demographics
NPI:1699422154
Name:TINAL, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:TINAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:JEANINE
Other - Last Name:CORUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2360 STONY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4018
Mailing Address - Country:US
Mailing Address - Phone:502-493-8719
Mailing Address - Fax:
Practice Address - Street 1:2360 STONY BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4018
Practice Address - Country:US
Practice Address - Phone:502-493-8719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY011273Other183500000X-PHARMACIST