Provider Demographics
NPI:1235407354
Name:LIGHTFOOT, TAMARA I (RPH)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:I
Last Name:LIGHTFOOT
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 1:965 GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3423
Mailing Address - Country:US
Mailing Address - Phone:415-841-0507
Mailing Address - Fax:
Practice Address - Street 1:965 GENEVA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3423
Practice Address - Country:US
Practice Address - Phone:415-841-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist