Provider Demographics
NPI:1528460367
Name:TIAN, KERES TIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:KERES
Middle Name:TIAN
Last Name:TIAN
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 1:450 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-1832
Mailing Address - Country:US
Mailing Address - Phone:914-273-1231
Mailing Address - Fax:
Practice Address - Street 1:450 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1832
Practice Address - Country:US
Practice Address - Phone:914-273-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist