Provider Demographics
NPI:1174125751
Name:TINER, JAMES LYNN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LYNN
Last Name:TINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 LAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-8654
Mailing Address - Country:US
Mailing Address - Phone:979-877-9977
Mailing Address - Fax:
Practice Address - Street 1:1255 HIGHWAY 59 LOOP N
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-7810
Practice Address - Country:US
Practice Address - Phone:979-532-0641
Practice Address - Fax:979-532-0689
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist