Provider Demographics
NPI:1861637183
Name:DEMICHELE, TANYA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:MARIE
Last Name:DEMICHELE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N CARSON ST # 172
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1216
Mailing Address - Country:US
Mailing Address - Phone:916-765-4622
Mailing Address - Fax:916-765-4622
Practice Address - Street 1:1342 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5309
Practice Address - Country:US
Practice Address - Phone:775-782-0537
Practice Address - Fax:775-783-1973
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV 16291183500000X
CA53564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist