Provider Demographics
NPI:1861984056
Name:TAN, OFELIA SAYO (RPH)
Entity type:Individual
Prefix:
First Name:OFELIA
Middle Name:SAYO
Last Name:TAN
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 1:14735 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3679
Mailing Address - Country:US
Mailing Address - Phone:818-788-0208
Mailing Address - Fax:818-788-6159
Practice Address - Street 1:14735 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3679
Practice Address - Country:US
Practice Address - Phone:818-788-0208
Practice Address - Fax:818-788-6159
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA058118333600000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy