=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033483714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMMY BS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2012
-----------------------------------------------------
Last Update Date | 02/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2131 N CENTER ST
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72701-9449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-643-3303
-----------------------------------------------------
Fax | 479-643-2226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 83
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72702-0083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-643-3303
-----------------------------------------------------
Fax | 479-643-2226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER,/ RPH MANAGER
-----------------------------------------------------
Name | TAMMY BITZER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 479-643-3303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | AR20669
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------