Healthcare Provider Details

I. General information

NPI: 1922775766
Provider Name (Legal Business Name): MEGAN TANWANSENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

IV. Provider business mailing address

PO BOX 245
LA PUENTE CA
91747-0245
US

V. Phone/Fax

Practice location:
  • Phone: 747-210-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: