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General NPI Number Information
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NPI Number | 1639448426
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Entity Type | Individual
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Provider Name | MAYA ANGELA TATUM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 701 N WALES RD
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City | NORTH WALES
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State | PA
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Zip | 19454-2754
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Country | US
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Telephone | 215-412-8709
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Fax |
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Provider Business Mailing Address
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Address Line | 624 S CLIFTON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1921
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Country | US
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Telephone | 267-773-8651
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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 | RPI005647
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License Number State | PA
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Taxonomy #2
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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 | RP441117
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License Number State | PA
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