Provider Demographics
NPI:1770120834
Name:TANKEU, RAISSA SARAH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RAISSA
Middle Name:SARAH
Last Name:TANKEU
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 1:4333 ANTILLEY RD APT 1204
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-6063
Mailing Address - Country:US
Mailing Address - Phone:240-274-6164
Mailing Address - Fax:
Practice Address - Street 1:1319 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-3312
Practice Address - Country:US
Practice Address - Phone:325-643-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX574251835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care