Provider Demographics
NPI:1053941278
Name:STRAYHORN, VINA JEANETTE
Entity type:Individual
Prefix:
First Name:VINA
Middle Name:JEANETTE
Last Name:STRAYHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79550-1342
Mailing Address - Country:US
Mailing Address - Phone:325-280-8104
Mailing Address - Fax:
Practice Address - Street 1:3706 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-4625
Practice Address - Country:US
Practice Address - Phone:325-573-7582
Practice Address - Fax:325-573-9023
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist