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General NPI Number Information
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NPI Number | 1588775100
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Entity Type | Individual
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Provider Name | TAMRA RENEE POPE R.PH.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 297 N MARION AVE
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City | LAKE CITY
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State | FL
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Zip | 32055-2866
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Country | US
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Telephone | 386-752-1793
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Fax |
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Provider Business Mailing Address
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Address Line | 329 SW DEPUTY J DAVIS LN
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City | LAKE CITY
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State | FL
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Zip | 32024-3739
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Country | US
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Telephone | 386-752-3202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS0032725
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License Number State | FL
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