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General NPI Number Information
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NPI Number | 1720069057
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Entity Type | Individual
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Provider Name | CASSANDRA GORDON TANCIL PHARM.D., BCPS
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Gender | Female
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2051 EAGLE RIDGE DR SW
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City | CONYERS
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State | GA
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Zip | 30094-3379
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Country | US
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Telephone | 678-413-1338
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Fax | 678-413-9164
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Provider Business Mailing Address
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Address Line | 2051 EAGLE RIDGE DR SW
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City | CONYERS
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State | GA
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Zip | 30094-3379
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Country | US
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Telephone | 678-413-1715
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Fax | 678-413-9164
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RPH019901
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License Number State | GA
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