Provider Demographics
NPI:1063630531
Name:MCDERMOTT, TANIA (RPH)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-5012
Mailing Address - Country:US
Mailing Address - Phone:561-588-8740
Mailing Address - Fax:
Practice Address - Street 1:324 DATURA ST
Practice Address - Street 2:SUITE 401
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5414
Practice Address - Country:US
Practice Address - Phone:561-659-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist