Provider Demographics
NPI:1255933503
Name:TAMAKLOE, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:TAMAKLOE
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 1:23002 EASTGATE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8131
Mailing Address - Country:US
Mailing Address - Phone:713-979-8755
Mailing Address - Fax:
Practice Address - Street 1:18700 HIGHWAY 105 W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5625
Practice Address - Country:US
Practice Address - Phone:936-582-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist