Provider Demographics
NPI:1932702123
Name:TANTOH, PATIENCE A
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:A
Last Name:TANTOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15482 CHRISTOPHER LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-3670
Mailing Address - Country:US
Mailing Address - Phone:214-714-1842
Mailing Address - Fax:940-442-6767
Practice Address - Street 1:1776 TEASLEY LN STE 111
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7710
Practice Address - Country:US
Practice Address - Phone:940-442-6767
Practice Address - Fax:940-442-6563
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist