Provider Demographics
NPI:1447897251
Name:SYRIAC, TINA THOMAS (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:THOMAS
Last Name:SYRIAC
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23989 WESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3658
Mailing Address - Country:US
Mailing Address - Phone:734-634-1020
Mailing Address - Fax:
Practice Address - Street 1:47650 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1217
Practice Address - Country:US
Practice Address - Phone:248-374-9714
Practice Address - Fax:248-374-8459
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-30
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist