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General NPI Number Information
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NPI Number | 1275048720
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Entity Type | Individual
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Provider Name | VIRGINIA GRACE LEW TAN
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Gender | Female
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 1710 N FARMERSVILLE BLVD
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City | FARMERSVILLE
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State | CA
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Zip | 93223-2306
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Country | US
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Telephone | 559-747-3317
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7756
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City | ALHAMBRA
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State | CA
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Zip | 91802-7756
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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 | 78043
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License Number State | CA
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