Provider Demographics
NPI:1700012341
Name:TAVLARIOS, ANNA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:TAVLARIOS
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 1:4500 HIGH VISTA CR NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714
Mailing Address - Country:US
Mailing Address - Phone:330-484-3947
Mailing Address - Fax:330-484-9470
Practice Address - Street 1:2906 CLEVELAND AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3624
Practice Address - Country:US
Practice Address - Phone:330-484-3947
Practice Address - Fax:330-484-9470
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist