Provider Demographics
NPI:1194879106
Name:LITTERER, TAMRA
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:LITTERER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18607 VAIL AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50619-9624
Mailing Address - Country:US
Mailing Address - Phone:319-278-1195
Mailing Address - Fax:
Practice Address - Street 1:312 9TH ST SW STE 1000
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-483-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist