Provider Demographics
NPI:1427349703
Name:MCVICKER, TAMMIE (RPH)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:MCVICKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11780 1232 S. HWY. 74
Mailing Address - Street 2:RITE AID 11780
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269
Mailing Address - Country:US
Mailing Address - Phone:770-716-7076
Mailing Address - Fax:770-716-7076
Practice Address - Street 1:1232 S. HWY 74
Practice Address - Street 2:RITE AID 11780
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:770-631-3766
Practice Address - Fax:770-631-7765
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist