Provider Demographics
NPI:1215763347
Name:TATOM, DARIA ANNETTE
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:ANNETTE
Last Name:TATOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 SOUTH AVE APT F10
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4409
Mailing Address - Country:US
Mailing Address - Phone:267-673-0054
Mailing Address - Fax:
Practice Address - Street 1:4098 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2211
Practice Address - Country:US
Practice Address - Phone:610-876-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist