Provider Demographics
NPI:1538453550
Name:SILLATO, TANYA STEFANIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:STEFANIE
Last Name:SILLATO
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 1:594 RIVER HWY
Mailing Address - Street 2:TARGET 1505
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6829
Mailing Address - Country:US
Mailing Address - Phone:704-799-1477
Mailing Address - Fax:704-799-1477
Practice Address - Street 1:594 RIVER HWY
Practice Address - Street 2:TARGET 1505
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6829
Practice Address - Country:US
Practice Address - Phone:704-799-1477
Practice Address - Fax:704-799-1477
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist