Provider Demographics
NPI:1235885534
Name:AVERA, TAMARA W (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:W
Last Name:AVERA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 MAE ANNE AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-4707
Mailing Address - Country:US
Mailing Address - Phone:775-787-1144
Mailing Address - Fax:
Practice Address - Street 1:6140 MAE ANNE AVE STE 1B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-4707
Practice Address - Country:US
Practice Address - Phone:775-787-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPT21786183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2989448Medicaid
NVPT21786Medicaid