MEDICARE: DR. RAISSA SARAH TANKEU PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P2201X	Ambulatory Care Pharmacist	57425	TX

General Provider Information

NPI Number	:	1770120834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAISSA SARAH TANKEU PHARMD

Provider Business Mailing Address
First Line	:	4333 ANTILLEY RD APT 1204
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79606-6063
Country	:	US
Telephone Number	:	240-274-6164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 AUSTIN AVE
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-3312
Country	:	US
Telephone Number	:	325-643-1516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2019
Last Update Date	:	12/06/2019

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