Provider Demographics
NPI:1184956112
Name:TANJUTCO, MA JERRYLINN OCAMPO
Entity type:Individual
Prefix:
First Name:MA JERRYLINN
Middle Name:OCAMPO
Last Name:TANJUTCO
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 1:808 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9136
Mailing Address - Country:US
Mailing Address - Phone:360-687-5136
Mailing Address - Fax:360-687-5186
Practice Address - Street 1:808 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9136
Practice Address - Country:US
Practice Address - Phone:360-687-5136
Practice Address - Fax:360-687-5186
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60022930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist