Provider Demographics
NPI:1891213922
Name:TANGONAN, JAIME-ROSE CAYME (RPH)
Entity Type:Individual
Prefix:
First Name:JAIME-ROSE
Middle Name:CAYME
Last Name:TANGONAN
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 1:72 NE HADLEY WAY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-2173
Mailing Address - Country:US
Mailing Address - Phone:808-494-8711
Mailing Address - Fax:
Practice Address - Street 1:1350 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838
Practice Address - Country:US
Practice Address - Phone:541-567-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH-60752150183500000X
HIPH-4311183500000X
ORRPH-0016171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist