Provider Demographics
NPI:1568612604
Name:TABER, DEAN RICHARD (CPHT)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:RICHARD
Last Name:TABER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10767 JAMACHA BLVD SPC 142
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1859
Mailing Address - Country:US
Mailing Address - Phone:619-254-9983
Mailing Address - Fax:
Practice Address - Street 1:10767 JAMACHA BLVD SPC 142
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1859
Practice Address - Country:US
Practice Address - Phone:619-254-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH 14036183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician