Provider Demographics
NPI:1679173884
Name:CANTIN, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:CANTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 INTERSTATE 35 N
Mailing Address - Street 2:
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-4466
Mailing Address - Country:US
Mailing Address - Phone:830-663-5964
Mailing Address - Fax:
Practice Address - Street 1:175 INTERSTATE 35 N
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-4466
Practice Address - Country:US
Practice Address - Phone:830-663-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist