MEDICARE: TAMI UPSHAW

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	42316	SC

General Provider Information

NPI Number	:	1255961231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMI UPSHAW

Provider Business Mailing Address
First Line	:	781 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3029
Country	:	US
Telephone Number	:	770-823-5611
Fax Number	:

Provider Business Practice Location Address
First Line	:	781 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3029
Country	:	US
Telephone Number	:	843-249-9967
Fax Number	:	843-280-3643

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

Provider Enumeration Date	:	01/18/2020
Last Update Date	:	01/18/2020

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Directions to “ TAMI UPSHAW ” Practice Location

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