Provider Demographics
NPI:1679606743
Name:TANABE, KLIP ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KLIP
Middle Name:ALAN
Last Name:TANABE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9606
Mailing Address - Country:US
Mailing Address - Phone:734-973-1210
Mailing Address - Fax:734-677-7165
Practice Address - Street 1:3825 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9606
Practice Address - Country:US
Practice Address - Phone:734-973-1210
Practice Address - Fax:734-677-7165
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist