Individual
BRIGETTE SHARIE TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED PHARMACIS
Contact information
Practice address
2700 CENTRAL FWY, WICHITA FALLS, TX 76306-2843
(940) 855-2374
Mailing address
2700 CENTRAL FWY, WICHITA FALLS, TX 76306-2843
(940) 855-2374
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
34945
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34945
STATE BOARD OF TEXAS
TX
Enumeration date
10/10/2019
Last updated
10/10/2019
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