Provider Demographics
NPI:1053021154
Name:TANKAM, ROBERTSON FORCHIKA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTSON
Middle Name:FORCHIKA
Last Name:TANKAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4002
Mailing Address - Country:US
Mailing Address - Phone:806-797-4444
Mailing Address - Fax:
Practice Address - Street 1:3402 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4002
Practice Address - Country:US
Practice Address - Phone:806-797-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist