Provider Demographics
NPI:1568036408
Name:TAHARA-STOLLER, TRICIA JEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:JEAN
Last Name:TAHARA-STOLLER
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 1:1330 ETHEL ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1826
Mailing Address - Country:US
Mailing Address - Phone:310-989-7434
Mailing Address - Fax:
Practice Address - Street 1:1330 ETHEL ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1826
Practice Address - Country:US
Practice Address - Phone:310-989-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist