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General NPI Number Information
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NPI Number | 1467719179
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Entity Type | Individual
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Provider Name | THERESE JANE YNSON TAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 1136 CAPUCHINO AVE APT 5
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City | BURLINGAME
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State | CA
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Zip | 94010-3553
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Country | US
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Telephone | 650-921-3631
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Fax |
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Provider Business Mailing Address
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Address Line | 1136 CAPUCHINO AVE APT 5
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City | BURLINGAME
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State | CA
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Zip | 94010-3553
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Country | US
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Telephone | 650-921-3631
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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 | 66953
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License Number State | CA
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