Healthcare Provider Details

I. General information

NPI: 1104514660
Provider Name (Legal Business Name): TAMMY VIGNEAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CHERRY AVE
LONG BEACH CA
90802-3930
US

IV. Provider business mailing address

211 CHERRY AVE
LONG BEACH CA
90802-3930
US

V. Phone/Fax

Practice location:
  • Phone: 562-951-1360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number9003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: