MEDICARE: TAMMY LYNN TODD PHARMACY TECHNICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	10122830	MI

General Provider Information

NPI Number	:	1063080604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY LYNN TODD PHARMACY TECHNICIAN

Provider Business Mailing Address
First Line	:	411 N COURT ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1801
Country	:	US
Telephone Number	:	616-824-1943
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 N LAFAYETTE ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1166
Country	:	US
Telephone Number	:	616-754-3625
Fax Number	:	616-754-2726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

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