Provider Demographics
NPI:1588833891
Name:TANK, PATRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:TANK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 W GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9165
Mailing Address - Country:US
Mailing Address - Phone:386-677-4215
Mailing Address - Fax:386-673-8509
Practice Address - Street 1:1478 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9165
Practice Address - Country:US
Practice Address - Phone:386-677-4215
Practice Address - Fax:386-673-8509
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS27818OtherSTATE LICENSE NUMBER