Provider Demographics
NPI:1013135847
Name:TANBAKUCHI, NADERE - (RPH)
Entity Type:Individual
Prefix:
First Name:NADERE
Middle Name:-
Last Name:TANBAKUCHI
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 1:40612 PAISLEY CIR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1626
Mailing Address - Country:US
Mailing Address - Phone:248-960-4779
Mailing Address - Fax:
Practice Address - Street 1:41820 TEN MILE ROAD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:248-349-6150
Practice Address - Fax:248-349-4562
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist