Provider Demographics
NPI:1033490339
Name:COLBERT, TAMMY TORRENCE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:TORRENCE
Last Name:COLBERT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 FORT CAROLINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2035
Mailing Address - Country:US
Mailing Address - Phone:904-745-5826
Mailing Address - Fax:904-745-9782
Practice Address - Street 1:6103 FORT CAROLINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2035
Practice Address - Country:US
Practice Address - Phone:904-745-5826
Practice Address - Fax:904-745-9782
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist