Healthcare Provider Details

I. General information

NPI: 1669116091
Provider Name (Legal Business Name): TAN HO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 E BROADWAY RD
MESA AZ
85204-1530
US

IV. Provider business mailing address

2113 E MORELOS ST
CHANDLER AZ
85225-2376
US

V. Phone/Fax

Practice location:
  • Phone: 480-464-4742
  • Fax: 480-644-0964
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS022358
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: