1972546034 NPI number — DR. TANYA L CLAIBORNE PHARM.D.

Table of content: LAURYN O'HARA (NPI 1720697535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972546034 NPI number — DR. TANYA L CLAIBORNE PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAIBORNE
Provider First Name:
TANYA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972546034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 SPINNAKER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23185-5292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-736-1200
Provider Business Mailing Address Fax Number:
757-736-1217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 LOFTIS BOULEVARD
Provider Second Line Business Practice Location Address:
PORT WARWICK II PHARMACY
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-736-1200
Provider Business Practice Location Address Fax Number:
757-736-1217
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0202207128 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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