Provider Demographics
NPI:1093064222
Name:VAN VEEN, TAMARA S (RPH)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:VAN VEEN
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 1:4716 FURZEE RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99110-9612
Mailing Address - Country:US
Mailing Address - Phone:509-276-1159
Mailing Address - Fax:
Practice Address - Street 1:406 N PARK ST
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8972
Practice Address - Country:US
Practice Address - Phone:509-935-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00044742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist