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General NPI Number Information
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NPI Number | 1861983876
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Entity Type | Individual
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Provider Name | TATYANA STOTSKAYA
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Gender | Female
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 180 DONAHUE ST
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City | SAUSALITO
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State | CA
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Zip | 94965-1250
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Country | US
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Telephone | 415-531-6256
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 LOMBARD ST APT 1
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-3181
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Country | US
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Telephone | 415-531-6256
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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 | 77226
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License Number State | CA
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