Provider Demographics
NPI:1467554154
Name:TAO, DEBRA JEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JEAN
Last Name:TAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:JEAN
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:91 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4111
Mailing Address - Country:US
Mailing Address - Phone:310-541-9174
Mailing Address - Fax:
Practice Address - Street 1:351 E TEMPLE ST
Practice Address - Street 2:DEPT 119- PHARMACY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3328
Practice Address - Country:US
Practice Address - Phone:213-253-2677
Practice Address - Fax:213-253-5019
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 41343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist