Provider Demographics
NPI:1003328691
Name:HARTY, TAMI LOUISE
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:LOUISE
Last Name:HARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:LOUISE
Other - Last Name:HAMMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2204 UNION RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6014
Mailing Address - Country:US
Mailing Address - Phone:704-864-8886
Mailing Address - Fax:704-867-3297
Practice Address - Street 1:2204 UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-6014
Practice Address - Country:US
Practice Address - Phone:704-864-8886
Practice Address - Fax:704-867-3297
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist