MEDICARE: STEPHANIE KAMDOUM TAMEZE PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03232856	OH

General Provider Information

NPI Number	:	1821693565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KAMDOUM TAMEZE PHARMD.

Provider Business Mailing Address
First Line	:	32 N LUDLOW ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-1826
Country	:	US
Telephone Number	:	937-228-9145
Fax Number	:	937-228-7111

Provider Business Practice Location Address
First Line	:	32 N LUDLOW ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-1826
Country	:	US
Telephone Number	:	937-228-9145
Fax Number	:	937-228-7111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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