Provider Demographics
NPI:1073814190
Name:PEDERSEN, TAMMI MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:MARIE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9647
Mailing Address - Country:US
Mailing Address - Phone:541-504-4166
Mailing Address - Fax:541-504-4168
Practice Address - Street 1:1705 S HWY 97
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1189
Practice Address - Country:US
Practice Address - Phone:541-504-4166
Practice Address - Fax:541-504-4168
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111141835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist