Provider Demographics
NPI:1952766347
Name:REVEGGINO SOSA DE PINTO, TANIA C (RPH)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:C
Last Name:REVEGGINO SOSA DE PINTO
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 1:3811 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1466
Mailing Address - Country:US
Mailing Address - Phone:586-268-1888
Mailing Address - Fax:
Practice Address - Street 1:4135 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5400
Practice Address - Country:US
Practice Address - Phone:586-268-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist