Provider Demographics
NPI:1215314919
Name:TAMBOT, MARIE ANTONETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIE ANTONETTE
Middle Name:
Last Name:TAMBOT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2736
Mailing Address - Country:US
Mailing Address - Phone:650-278-9980
Mailing Address - Fax:
Practice Address - Street 1:577 LISBON ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2736
Practice Address - Country:US
Practice Address - Phone:650-278-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist