=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689118069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIAN TAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2016
-----------------------------------------------------
Last Update Date | 12/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1795 E CAPITOL EXPY
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95121-1561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-238-5890
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 648 SAN PATRICIO AVE
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94085-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-718-9626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 76016
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------