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General NPI Number Information
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NPI Number | 1790125375
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Entity Type | Individual
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Provider Name | TABATHA M ENGALND
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Gender | Female
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 612 W STOCKTON ST
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City | EDMONTON
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State | KY
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Zip | 42129-9458
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Country | US
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Telephone | 270-432-3865
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Fax | 270-432-7750
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Provider Business Mailing Address
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Address Line | 1825 ECHO RD
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City | KNOB LICK
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State | KY
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Zip | 42154-8341
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Country | US
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Telephone | 270-432-7574
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Fax | 270-432-7750
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PT00013046
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License Number State | KY
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