Provider Demographics
NPI:1891332136
Name:TANNOUZ, ANA MAY TAN (PHARMD, APH)
Entity Type:Individual
Prefix:
First Name:ANA MAY
Middle Name:TAN
Last Name:TANNOUZ
Suffix:
Gender:F
Credentials:PHARMD, APH
Other - Prefix:
Other - First Name:ANA MAY
Other - Middle Name:VINLUAN
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:16433 CEDAR VIEW LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4740
Mailing Address - Country:US
Mailing Address - Phone:818-425-4358
Mailing Address - Fax:
Practice Address - Street 1:16433 CEDAR VIEW LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4740
Practice Address - Country:US
Practice Address - Phone:818-425-4358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist