Provider Demographics
NPI:1871104869
Name:TAY, FLYNNICK (PHARMD)
Entity type:Individual
Prefix:
First Name:FLYNNICK
Middle Name:
Last Name:TAY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25620 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1665
Mailing Address - Country:US
Mailing Address - Phone:281-371-2360
Mailing Address - Fax:
Practice Address - Street 1:14616 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7517
Practice Address - Country:US
Practice Address - Phone:281-493-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist