Healthcare Provider Details

I. General information

NPI: 1598065237
Provider Name (Legal Business Name): TAMMY J BUMGARNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 NININGER RD
HASTINGS MN
55033-1056
US

IV. Provider business mailing address

1175 NININGER RD
HASTINGS MN
55033-1056
US

V. Phone/Fax

Practice location:
  • Phone: 651-480-4261
  • Fax: 651-480-4266
Mailing address:
  • Phone: 651-480-4261
  • Fax: 651-480-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115801
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 00018577
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: