Provider Demographics
NPI:1770565806
Name:TAVAREZ, ANGELA GAIL (RPH)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:GAIL
Last Name:TAVAREZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:GAIL
Other - Last Name:SPELIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:53 FRUITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-5424
Mailing Address - Country:US
Mailing Address - Phone:831-724-0587
Mailing Address - Fax:
Practice Address - Street 1:75 NIELSON ST
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2468
Practice Address - Country:US
Practice Address - Phone:831-763-6440
Practice Address - Fax:831-763-6444
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist