Provider Demographics
NPI:1528111440
Name:HAUCK, TANYA (RPH)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:HAUCK
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 1:5470 BROOKDALE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3618
Mailing Address - Country:US
Mailing Address - Phone:248-882-7553
Mailing Address - Fax:
Practice Address - Street 1:39625 LEWIS DR
Practice Address - Street 2:SUITE 800
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2972
Practice Address - Country:US
Practice Address - Phone:800-688-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist