Healthcare Provider Details

I. General information

NPI: 1598155582
Provider Name (Legal Business Name): TAMARA FRIDAY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAIN ST
SOUTH HUTCHINSON KS
67505-1123
US

IV. Provider business mailing address

503 N MAIN ST
SOUTH HUTCHINSON KS
67505-1123
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-2258
  • Fax: 620-663-8340
Mailing address:
  • Phone: 620-663-2258
  • Fax: 620-663-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-11998
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: