Basic Information
| Provider Information | |||||||||
| NPI: | 1740549575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANIYAMA | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 E H ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919107807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194824405 | ||||||||
| FaxNumber: | 6196565919 | ||||||||
| Practice Location | |||||||||
| Address1: | 895 E H ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919107807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194824405 | ||||||||
| FaxNumber: | 6196565919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2012 | ||||||||
| LastUpdateDate: | 05/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 289041 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.