MEDICARE: TANYA GOLOVANOFF PHARMD, BCSCP

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	20453	CO

General Provider Information

NPI Number	:	1174190920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA GOLOVANOFF PHARMD, BCSCP

Provider Business Mailing Address
First Line	:	915 CENTRE AVE STE 3
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6046
Country	:	US
Telephone Number	:	970-494-2130
Fax Number	:	970-494-2131

Provider Business Practice Location Address
First Line	:	915 CENTRE AVE STE 3
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6046
Country	:	US
Telephone Number	:	970-494-2130
Fax Number	:	970-494-2131

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

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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