Provider Demographics
NPI:1720590474
Name:AUSTIN, TAMMIE (PHARMD, MBA)
Entity type:Individual
Prefix:MS
First Name:TAMMIE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 N. 28TH DR.
Mailing Address - Street 2:BUILDING E, SUITE 2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5616
Mailing Address - Country:US
Mailing Address - Phone:602-892-5155
Mailing Address - Fax:602-281-7284
Practice Address - Street 1:11221 N. 28TH DR.
Practice Address - Street 2:BUILDING E, SUITE 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5616
Practice Address - Country:US
Practice Address - Phone:602-892-5155
Practice Address - Fax:602-281-1284
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012832183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician