Provider Demographics
NPI:1841518511
Name:TAMMARA, RANDY (PHARMD CDE)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:TAMMARA
Suffix:
Gender:M
Credentials:PHARMD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ANDREW RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-7902
Mailing Address - Country:US
Mailing Address - Phone:215-880-8536
Mailing Address - Fax:215-722-8091
Practice Address - Street 1:7601 CASTOR AVE
Practice Address - Street 2:LOBBY LEVEL SUITE 100
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-4026
Practice Address - Country:US
Practice Address - Phone:215-880-8536
Practice Address - Fax:215-722-8091
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039233L1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02370800OtherNEW JERSEY STATE BOARD OF PHARMACY
2001-0518OtherCERTIFIED DIABETES EDUCATOR
PARP039233LOtherPENNSYLVANIA STATE BOARD OF PHARMACY
FLPS 44978OtherFLORIDA STATE BOARD OF PHARMACY