Provider Demographics
NPI:1073804613
Name:KEIBLER, TAMARA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:KEIBLER
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 1:227 FOUNTAINHEAD LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5417
Mailing Address - Country:US
Mailing Address - Phone:910-433-3897
Mailing Address - Fax:910-433-3869
Practice Address - Street 1:227 FOUNTAINHEAD LN
Practice Address - Street 2:SUITE 104
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5417
Practice Address - Country:US
Practice Address - Phone:910-433-3897
Practice Address - Fax:910-433-3869
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-01
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist