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General NPI Number Information
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NPI Number | 1619476272
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Entity Type | Individual
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Provider Name | ELAINE STEPHANIE TAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 20 YORK ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-688-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 616 NEW PARK AVE APT 202
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1344
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Country | US
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Telephone | 702-882-7506
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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 | 77428
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0015437
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License Number State | CT
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