Provider Demographics
NPI:1912992306
Name:USHIO, TAMIKO L (RPH)
Entity type:Individual
Prefix:
First Name:TAMIKO
Middle Name:L
Last Name:USHIO
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 1:2546 E 2ND ST
Mailing Address - Street 2:BLDG 100
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2047
Mailing Address - Country:US
Mailing Address - Phone:307-472-0597
Mailing Address - Fax:307-237-7731
Practice Address - Street 1:2546 E 2ND ST
Practice Address - Street 2:BUILDING 100
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2047
Practice Address - Country:US
Practice Address - Phone:307-472-0597
Practice Address - Fax:307-237-7731
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY2558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist