Provider Demographics
NPI:1174225494
Name:FERREIRA-BLACK, TATIANA (RPH)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:FERREIRA-BLACK
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 1:807 MARINER
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4351
Mailing Address - Country:US
Mailing Address - Phone:512-800-2885
Mailing Address - Fax:
Practice Address - Street 1:807 MARINER
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4351
Practice Address - Country:US
Practice Address - Phone:512-800-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist