MEDICARE: VIVIAN L TAN PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	032110	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164603585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN L TAN PHARMACIST

Provider Business Mailing Address
First Line	:	35 MONTGOMERY ST APT 8G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-6528
Country	:	US
Telephone Number	:	212-608-2578
Fax Number	:

Provider Business Practice Location Address
First Line	:	2155 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-4707
Country	:	US
Telephone Number	:	212-534-9781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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Directions to “ VIVIAN L TAN PHARMACIST” Practice Location

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