Individual
GAYLE M TANENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, RPH
Contact information
Practice address
1401 BULLOCH LAKE CT, LOGANVILLE, GA 30052-8649
(770) 554-1429
(770) 544-0929
Mailing address
1401 BULLOCH LAKE CT, LOGANVILLE, GA 30052-8649
(770) 554-1429
(770) 544-0929
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
RPH022160
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH022160
PHARMACIST LICENSE
GA
Enumeration date
01/21/2015
Last updated
01/21/2015
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