Provider Demographics
NPI:1073815965
Name:VATANKA, PARISA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PARISA
Middle Name:
Last Name:VATANKA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 BOLLINGER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4959
Mailing Address - Country:US
Mailing Address - Phone:925-359-2005
Mailing Address - Fax:925-359-2006
Practice Address - Street 1:11050 BOLLINGER CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4959
Practice Address - Country:US
Practice Address - Phone:925-359-2005
Practice Address - Fax:925-359-2006
Is Sole Proprietor?:No
Enumeration Date:2010-11-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist