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General NPI Number Information
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NPI Number | 1215326707
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Entity Type | Individual
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Provider Name | GAYLE M TANENBAUM BS, RPH
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Gender | Female
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 1401 BULLOCH LAKE CT
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City | LOGANVILLE
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State | GA
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Zip | 30052-8649
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Country | US
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Telephone | 770-554-1429
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Fax | 770-544-0929
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Provider Business Mailing Address
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Address Line | 1401 BULLOCH LAKE CT
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City | LOGANVILLE
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State | GA
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Zip | 30052-8649
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Country | US
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Telephone | 770-554-1429
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Fax | 770-544-0929
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH022160
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License Number State | GA
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