Provider Demographics
NPI:1912420829
Name:VAN CLEAVE, TANYA MCGINNIS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:MCGINNIS
Last Name:VAN CLEAVE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SNOW ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1270
Mailing Address - Country:US
Mailing Address - Phone:256-831-7535
Mailing Address - Fax:256-831-4461
Practice Address - Street 1:601 SNOW ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1270
Practice Address - Country:US
Practice Address - Phone:256-831-7535
Practice Address - Fax:256-831-4461
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL127611835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12761OtherPHARMACY LICENSE