Provider Demographics
NPI:1730636002
Name:EHRLICH MAYBLUM, TALI
Entity Type:Individual
Prefix:MRS
First Name:TALI
Middle Name:
Last Name:EHRLICH MAYBLUM
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 1:1123 S CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4413
Mailing Address - Country:US
Mailing Address - Phone:925-933-8353
Mailing Address - Fax:925-933-1935
Practice Address - Street 1:1123 S CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4413
Practice Address - Country:US
Practice Address - Phone:925-933-8353
Practice Address - Fax:925-933-1935
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA941059121OtherCVS