Provider Demographics
NPI:1629291513
Name:PALAZZO, TANIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:
Last Name:PALAZZO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 NW 23RD PLACE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-226-6211
Mailing Address - Fax:503-226-5390
Practice Address - Street 1:13 NW 23RD PLACE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-226-6211
Practice Address - Fax:503-226-5390
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00067685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist