Basic Information
| Provider Information | |||||||||
| NPI: | 1215240692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | TRINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3663 BRIARPARK DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770425205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132683630 | ||||||||
| FaxNumber: | 6238691717 | ||||||||
| Practice Location | |||||||||
| Address1: | 4215 S CARRIER PKWY | ||||||||
| Address2: | |||||||||
| City: | GRAND PRAIRIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750523203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722667056 | ||||||||
| FaxNumber: | 9722667087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2010 | ||||||||
| LastUpdateDate: | 07/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 34217 | TX | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.