Healthcare Provider Details

I. General information

NPI: 1649899915
Provider Name (Legal Business Name): TAMMY LYNN BERRY PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15009 TELEGRAPH RD
TAYLOR MI
48180-5117
US

IV. Provider business mailing address

15009 TELEGRAPH RD
TAYLOR MI
48180-5117
US

V. Phone/Fax

Practice location:
  • Phone: 734-374-2101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: