Provider Demographics
NPI:1457995573
Name:POURSHAMS-MANZOURI, TANIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:POURSHAMS-MANZOURI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1534
Mailing Address - Country:US
Mailing Address - Phone:520-325-3427
Mailing Address - Fax:520-326-0332
Practice Address - Street 1:3627 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1534
Practice Address - Country:US
Practice Address - Phone:520-325-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist