Healthcare Provider Details

I. General information

NPI: 1992317333
Provider Name (Legal Business Name): DR. TAMMY PENDLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11609 S SAGINAW ST
GRAND BLANC MI
48439-1354
US

IV. Provider business mailing address

811 WESTWOOD DR
FENTON MI
48430-1465
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-4983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302043245
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: