Provider Demographics
NPI:1053620039
Name:RIFE, TESSA LYNNE (PHARMD)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:LYNNE
Last Name:RIFE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5283 OLD BROWNSVILLE RD
Mailing Address - Street 2:119
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-3908
Mailing Address - Country:US
Mailing Address - Phone:361-806-5645
Mailing Address - Fax:361-806-5616
Practice Address - Street 1:5283 OLD BROWNSVILLE RD
Practice Address - Street 2:119
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-3908
Practice Address - Country:US
Practice Address - Phone:361-806-5645
Practice Address - Fax:361-806-5616
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist