Provider Demographics
NPI:1619788833
Name:PHILIP, PHINEY TREESA
Entity type:Individual
Prefix:
First Name:PHINEY
Middle Name:TREESA
Last Name:PHILIP
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 1:6303 SIENNA RANCH RD APT 2111
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4787
Mailing Address - Country:US
Mailing Address - Phone:346-347-9407
Mailing Address - Fax:
Practice Address - Street 1:12225 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8805
Practice Address - Country:US
Practice Address - Phone:281-431-4248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX371293183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician