Provider Demographics
NPI:1174190920
Name:GOLOVANOFF, TANYA (PHARMD, BCSCP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:GOLOVANOFF
Suffix:
Gender:F
Credentials:PHARMD, BCSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 CENTRE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6046
Mailing Address - Country:US
Mailing Address - Phone:970-494-2130
Mailing Address - Fax:970-494-2131
Practice Address - Street 1:915 CENTRE AVE STE 3
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6046
Practice Address - Country:US
Practice Address - Phone:970-494-2130
Practice Address - Fax:970-494-2131
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist