MEDICARE: TAMMI SUE HALEY PHARMD

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	183500000X	Pharmacist	PD7634	AR

General Provider Information

NPI Number	:	1417579970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMI SUE HALEY PHARMD

Provider Business Mailing Address
First Line	:	620 W SOUTH ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-4258
Country	:	US
Telephone Number	:	501-778-3151
Fax Number	:	501-778-7329

Provider Business Practice Location Address
First Line	:	620 W SOUTH ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-4258
Country	:	US
Telephone Number	:	501-788-3151
Fax Number	:	501-778-7329

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

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	10/29/2020

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