Provider Demographics
NPI:1225494768
Name:DENETCLAW, TINA HARRACH (PHARMD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:HARRACH
Last Name:DENETCLAW
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 1:23 KIRKPATRICK DR
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-1415
Mailing Address - Country:US
Mailing Address - Phone:510-758-6407
Mailing Address - Fax:
Practice Address - Street 1:23 KIRKPATRICK DR
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-1415
Practice Address - Country:US
Practice Address - Phone:510-758-6407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 447181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist