Provider Demographics
NPI:1043534845
Name:WILHOIT, TAMARA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:WILHOIT
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 1:402 E BRIGGS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1982
Mailing Address - Country:US
Mailing Address - Phone:660-385-2147
Mailing Address - Fax:660-385-5397
Practice Address - Street 1:402 E BRIGGS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1982
Practice Address - Country:US
Practice Address - Phone:660-385-2147
Practice Address - Fax:660-385-5397
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600119804Medicaid