Provider Demographics
NPI:1841564077
Name:MAGOCHA, TANY (RPH)
Entity Type:Individual
Prefix:
First Name:TANY
Middle Name:
Last Name:MAGOCHA
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 1:426 WINDY KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-5338
Mailing Address - Country:US
Mailing Address - Phone:231-872-0665
Mailing Address - Fax:972-384-3500
Practice Address - Street 1:426 WINDY KNOLL DR
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-5338
Practice Address - Country:US
Practice Address - Phone:231-872-0665
Practice Address - Fax:972-384-3500
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver