Provider Demographics
NPI:1386921633
Name:HAASE, TAMERA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAMERA
Middle Name:LYNN
Last Name:HAASE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16880 79TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3716
Mailing Address - Country:US
Mailing Address - Phone:763-286-6630
Mailing Address - Fax:
Practice Address - Street 1:3255 VICKSBURG LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1317
Practice Address - Country:US
Practice Address - Phone:763-253-8917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist