Provider Demographics
NPI:1952730947
Name:TANAKAYA, TRACIE N (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:N
Last Name:TANAKAYA
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 1:200 WEBSTER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4108
Mailing Address - Country:US
Mailing Address - Phone:510-587-2626
Mailing Address - Fax:
Practice Address - Street 1:200 WEBSTER ST STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4108
Practice Address - Country:US
Practice Address - Phone:510-587-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57160183500000X
HIPH2053183500000X
COPHA15898183500000X
NV18180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist