Provider Demographics
NPI:1740549575
Name:TANIYAMA, JEFFREY K (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:TANIYAMA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 E H ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7807
Mailing Address - Country:US
Mailing Address - Phone:619-482-4405
Mailing Address - Fax:619-656-5919
Practice Address - Street 1:895 E H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7807
Practice Address - Country:US
Practice Address - Phone:619-482-4405
Practice Address - Fax:619-656-5919
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist