Provider Demographics
NPI:1861660466
Name:BUCCIARELLI, TANJA COLOMBINA (BS)
Entity Type:Individual
Prefix:MRS
First Name:TANJA
Middle Name:COLOMBINA
Last Name:BUCCIARELLI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15156 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3725
Mailing Address - Country:US
Mailing Address - Phone:718-767-2926
Mailing Address - Fax:
Practice Address - Street 1:1720 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2322
Practice Address - Country:US
Practice Address - Phone:718-823-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045563OtherRPH STATE LICENSE NUMBER