Healthcare Provider Details

I. General information

NPI: 1841603925
Provider Name (Legal Business Name): TANAL HOUMANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 E WILLIAMS FIELD ROAD
GILBERT AZ
85295
US

IV. Provider business mailing address

87 E WILLIMAS FIELD ROAD
GILBERT AZ
85295-9457
US

V. Phone/Fax

Practice location:
  • Phone: 602-237-8681
  • Fax:
Mailing address:
  • Phone: 626-353-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016083
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: