Individual
DR. EVANI S TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 358-4700
Mailing address
11433 MOUNTAIN VIEW DR UNIT 26, RANCHO CUCAMONGA, CA 91730-8347
(626) 497-0607
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
61305
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083794580
NPI
CA
05
—
PHE435930
—
CA
Enumeration date
09/09/2008
Last updated
09/09/2008
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