Healthcare Provider Details

I. General information

NPI: 1861694564
Provider Name (Legal Business Name): CHRISTOPHER D. TAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TAMC HI
96859-5001
US

IV. Provider business mailing address

3058 HIEHIE ST
HONOLULU HI
96822-1506
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-4264
  • Fax:
Mailing address:
  • Phone: 808-433-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH1661
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: