1558646505 NPI number — DR. TAMMIE ANNE SHOCKLEY PHARM.D.

Table of content: DR. TAMMIE ANNE SHOCKLEY PHARM.D. (NPI 1558646505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558646505 NPI number — DR. TAMMIE ANNE SHOCKLEY PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOCKLEY
Provider First Name:
TAMMIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558646505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 OLD US 231 S
Provider Second Line Business Mailing Address:
WALGREENS 10974
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-776-7008
Provider Business Mailing Address Fax Number:
765-477-6480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 OLD US 231 S
Provider Second Line Business Practice Location Address:
WALGREENS 10974
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-471-1013
Provider Business Practice Location Address Fax Number:
765-477-6480
Provider Enumeration Date:
10/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  260202001A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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