Provider Demographics
NPI:1720069057
Name:TANCIL, CASSANDRA GORDON (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:GORDON
Last Name:TANCIL
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2051 EAGLE RIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3379
Mailing Address - Country:US
Mailing Address - Phone:678-413-1715
Mailing Address - Fax:678-413-9164
Practice Address - Street 1:2051 EAGLE RIDGE DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3379
Practice Address - Country:US
Practice Address - Phone:678-413-1338
Practice Address - Fax:678-413-9164
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0199011835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy