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General NPI Number Information
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NPI Number | 1962145789
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Entity Type | Individual
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Provider Name | ANTHONY CHRISTIAN TAN RPH
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Gender | Male
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 3801 PELANDALE AVE
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City | MODESTO
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State | CA
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Zip | 95356-8300
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Country | US
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Telephone | 209-566-5214
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 SPY GLASS DR
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City | MODESTO
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State | CA
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Zip | 95356-9699
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Country | US
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Telephone | 209-566-5214
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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 | 86065
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License Number State | CA
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