Healthcare Provider Details

I. General information

NPI: 1386686939
Provider Name (Legal Business Name): SUBHASH C TANNAN M.S., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD PHARMACY SERVICE (P5PHAR)
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

1716 NW MILL POND RD
PORTLAND OR
97229-7549
US

V. Phone/Fax

Practice location:
  • Phone: 503-721-1431
  • Fax: 503-721-1481
Mailing address:
  • Phone: 503-297-4737
  • Fax: 503-297-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14732
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: