Provider Demographics
NPI:1558604959
Name:TAMBOT, ROSEMARIE BALTAZAR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:BALTAZAR
Last Name:TAMBOT
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:BALTAZAR
Other - Last Name:TAMBOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3632
Mailing Address - Country:US
Mailing Address - Phone:650-216-9800
Mailing Address - Fax:650-216-9805
Practice Address - Street 1:11 BERKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3632
Practice Address - Country:US
Practice Address - Phone:650-216-9800
Practice Address - Fax:650-216-9805
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist