Provider Demographics
NPI:1598311227
Name:TENNANT, JANINE GRACE LASTIMOSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:GRACE LASTIMOSA
Last Name:TENNANT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:GRACE DELOS REYES
Other - Last Name:LASTIMOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12122 KIRKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HERALD
Mailing Address - State:CA
Mailing Address - Zip Code:95638-9764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 DALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9718
Practice Address - Country:US
Practice Address - Phone:209-735-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist