| Doctor Name: | GAYLE M TANENBAUM |
| NPI Number: | 1215326707 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS, RPH |
| License Number: | RPH022160 |
| Business Practice Address: | 1401 Bulloch Lake Ct Loganville, GA - 300528649 |
| Business Phone Number: | 7705541429 |
| Business Fax Number: | 7705440929 |
| Mailing Address: | 1401 Bulloch Lake Ct, LOGANVILLE |
| State: | GA |
| Postal Code: | 300528649 |
| Phone Number: | 7705541429 |
| Fax Number: | 7705440929 |
| NPI Enumeration Date: | 01/21/2015 |
| NPI Last Update Date: | 01/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P0018X |
| License Number: | RPH022160 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |