Provider Demographics
NPI:1003185422
Name:TA, TAM VAN
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:VAN
Last Name:TA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 SPRING CREEK OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2005
Mailing Address - Country:US
Mailing Address - Phone:281-257-9330
Mailing Address - Fax:
Practice Address - Street 1:19710 HOLZWARTH RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-6215
Practice Address - Country:US
Practice Address - Phone:281-350-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist