Provider Demographics
NPI:1558716522
Name:TARLOW, PAMELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:TARLOW
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 1:629 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2503
Mailing Address - Country:US
Mailing Address - Phone:310-395-1131
Mailing Address - Fax:310-395-7861
Practice Address - Street 1:629 BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2503
Practice Address - Country:US
Practice Address - Phone:310-395-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist