Provider Demographics
NPI:1639327703
Name:TAPHORN, MISTY DAWN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:TAPHORN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 SUNFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-4811
Mailing Address - Country:US
Mailing Address - Phone:805-656-5821
Mailing Address - Fax:
Practice Address - Street 1:10790 SUNFLOWER ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-4811
Practice Address - Country:US
Practice Address - Phone:805-656-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006026100183500000X
SC11720183500000X
CA62149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist