Provider Demographics
NPI:1083986202
Name:DEROUIN, TAMMY KAY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:KAY
Last Name:DEROUIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15544 ALAMEDA PL
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8155
Mailing Address - Country:US
Mailing Address - Phone:317-437-7977
Mailing Address - Fax:
Practice Address - Street 1:5602 CAITO DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1346
Practice Address - Country:US
Practice Address - Phone:317-544-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024406A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist