Provider Demographics
NPI:1073238218
Name:HERSBERGER, TAMMY DEE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:DEE
Last Name:HERSBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:LAPEL
Mailing Address - State:IN
Mailing Address - Zip Code:46051-0427
Mailing Address - Country:US
Mailing Address - Phone:765-621-0809
Mailing Address - Fax:
Practice Address - Street 1:610 W MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6110
Practice Address - Country:US
Practice Address - Phone:765-457-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015733A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist