Provider Demographics
NPI:1992800726
Name:DEMANGE, TINA KAY (RPH)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:KAY
Last Name:DEMANGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 CALISTA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-8592
Mailing Address - Country:US
Mailing Address - Phone:440-327-4359
Mailing Address - Fax:216-445-7403
Practice Address - Street 1:9500 EUCLID AVE A22
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-445-7501
Practice Address - Fax:216-445-7403
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-21261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist