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General NPI Number Information
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NPI Number | 1821439597
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Entity Type | Individual
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Provider Name | MATTHEW JAMES TAMER
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Gender | Male
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 1150 OLD COUNTRY RD
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City | RIVERHEAD
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State | NY
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Zip | 11901-2073
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Country | US
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Telephone | 631-208-9424
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Fax |
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Provider Business Mailing Address
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Address Line | 8 TAJ CT
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City | CENTEREACH
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State | NY
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Zip | 11720-3650
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Country | US
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Telephone | 631-375-3372
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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 | 058060
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License Number State | NY
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