Provider Demographics
NPI:1043511033
Name:ROWE, TANIKA GRAVES
Entity type:Individual
Prefix:DR
First Name:TANIKA
Middle Name:GRAVES
Last Name:ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TANIKA
Other - Middle Name:LATOINE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2346 IVERSON ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6801
Mailing Address - Country:US
Mailing Address - Phone:301-423-0462
Mailing Address - Fax:301-423-5149
Practice Address - Street 1:2346 IVERSON ST
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6801
Practice Address - Country:US
Practice Address - Phone:301-423-0462
Practice Address - Fax:301-423-5149
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist