Healthcare Provider Details

I. General information

NPI: 1629467253
Provider Name (Legal Business Name): MICHAEL N TADROS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 TUCKER RD
TEHACHAPI CA
93561-2510
US

IV. Provider business mailing address

PO BOX 5864
LANCASTER CA
93539-5864
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-9232
  • Fax:
Mailing address:
  • Phone: 818-217-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: