Provider Demographics
NPI:1518391812
Name:FONG, TARYN JANEL (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:TARYN
Middle Name:JANEL
Last Name:FONG
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 1:4400 TOWN CENTER BLVD
Mailing Address - Street 2:T-2270
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7131
Mailing Address - Country:US
Mailing Address - Phone:916-605-0185
Mailing Address - Fax:916-605-1913
Practice Address - Street 1:4400 TOWN CENTER BLVD
Practice Address - Street 2:T-2270
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7131
Practice Address - Country:US
Practice Address - Phone:916-605-0185
Practice Address - Fax:916-605-1913
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist