Healthcare Provider Details

I. General information

NPI: 1285027862
Provider Name (Legal Business Name): STEPHEN TANSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10665 BIG BEND RD
RIVERVIEW FL
33579-7176
US

IV. Provider business mailing address

10665 BIG BEND RD
RIVERVIEW FL
33579-7176
US

V. Phone/Fax

Practice location:
  • Phone: 813-234-3216
  • Fax: 813-234-3264
Mailing address:
  • Phone: 813-234-3216
  • Fax: 813-234-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS19586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: