Healthcare Provider Details

I. General information

NPI: 1093269177
Provider Name (Legal Business Name): MARISELA TAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 08/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE # M39C
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

521 PARNASSUS AVE # C-152
SAN FRANCISCO CA
94143-2206
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68879
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number68879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: