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General NPI Number Information
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NPI Number | 1083489850
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Entity Type | Individual
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Provider Name | ALICIA MICHELLE TANABE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/21/2023
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 600 B ST
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City | LIVINGSTON
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State | CA
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Zip | 95334-9593
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Country | US
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Telephone | 833-789-5321
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Fax |
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Provider Business Mailing Address
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Address Line | 517 REDWING CT
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City | MERCED
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State | CA
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Zip | 95340-8351
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 89014
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License Number State | CA
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