Provider Demographics
NPI:1205468246
Name:TABAKA, KARIN MARIA (RPH)
Entity type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:MARIA
Last Name:TABAKA
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 1:809 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4883
Mailing Address - Country:US
Mailing Address - Phone:248-872-6395
Mailing Address - Fax:
Practice Address - Street 1:31111 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-7047
Practice Address - Country:US
Practice Address - Phone:586-276-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist