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NPI Code Detail

MEDICARE: TABATHA M ENGALND

MEDICARE: TABATHA M ENGALND
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
1183700000XPharmacy TechnicianPT00013046KY

General Provider Information

NPI Number : 1790125375
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABATHA M ENGALND
Provider Business Mailing Address
First Line : 1825 ECHO RD
Second Line :
City : KNOB LICK
State : KY
Zip : 42154-8341
Country : US
Telephone Number : 270-432-7574
Fax Number : 270-432-7750
Provider Business Practice Location Address
First Line : 612 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-9458
Country : US
Telephone Number : 270-432-3865
Fax Number : 270-432-7750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2013
Last Update Date : 06/27/2013

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Directions to “ TABATHA M ENGALND ” Practice Location

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