Provider Demographics
NPI:1033483714
Name:TAMMY BS PLLC
Entity Type:Organization
Organization Name:TAMMY BS PLLC
Other - Org Name:TAMMY B'S HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,/ RPH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-643-3303
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-0083
Mailing Address - Country:US
Mailing Address - Phone:479-643-3303
Mailing Address - Fax:479-643-2226
Practice Address - Street 1:2131 N CENTER ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-9449
Practice Address - Country:US
Practice Address - Phone:479-643-3303
Practice Address - Fax:479-643-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR206693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133944OtherPK
AR1033483714Medicaid
ARFT3064665OtherDEA
0423866OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AR6692540001Medicare NSC