Provider Demographics
NPI:1538437587
Name:TANIS, MICHEL ANGE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:ANGE
Last Name:TANIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MICHELANGE
Other - Middle Name:
Other - Last Name:TANIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 590367
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33359-0367
Mailing Address - Country:US
Mailing Address - Phone:850-322-3750
Mailing Address - Fax:305-320-1304
Practice Address - Street 1:13698 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1039
Practice Address - Country:US
Practice Address - Phone:305-221-4589
Practice Address - Fax:305-222-1258
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0040600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist