Healthcare Provider Details

I. General information

NPI: 1629086178
Provider Name (Legal Business Name): TAMRA M PIERCE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST RL ROUDEBUSH VA MEDICAL CENTER, DEPT. OF PHARMACY
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-4472
  • Fax:
Mailing address:
  • Phone: 317-988-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number1-13426
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: