Individual ProviderLionel Buma TitaPharmacistPharmacy Service ProvidersPractice Address5976 Old Jacksonville Hwy, Tyler, TX 75703-0582(903) 405-6215(713) 498-7149PECOS EnrollmentBased on the most recent information from CMS, provider Lionel Buma Tita does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1851976351Provider TypeIndividualFull NameTita, Lionel BumaGenderMaleSole ProprietorNoEnumeration Date3/16/2021Last Updated3/16/2021Contact InformationPractice LocationPractice Address5976 Old Jacksonville Hwy, Tyler, TX 75703-0582Phone(903) 405-6215FaxUnlisted FaxMailing LocationMailing Address322 Ambrose Ave, Tyler, TX 75704-2028Phone(713) 498-7149FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense68297TexasProvider IdentifiersIDDescriptionIssuerID34126033DescriptionOtherIssuerDRIVER'S LICENSETexas