Healthcare Provider Details

I. General information

NPI: 1174839658
Provider Name (Legal Business Name): TAMARA KUILANOFF PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 E WASHINGTON BLVD
PASADENA CA
91104-2650
US

IV. Provider business mailing address

129 N VAIL AVE
MONTEBELLO CA
90640-4037
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-0245
  • Fax: 626-296-0756
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: