Provider Demographics
NPI:1386686939
Name:TANNAN, SUBHASH C (MS, RPH)
Entity Type:Individual
Prefix:MR
First Name:SUBHASH
Middle Name:C
Last Name:TANNAN
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 NW MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7549
Mailing Address - Country:US
Mailing Address - Phone:503-297-4737
Mailing Address - Fax:503-297-4737
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:PHARMACY SERVICE (P5PHAR)
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-721-1431
Practice Address - Fax:503-721-1481
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist