Provider Demographics
NPI:1326338443
Name:CARLOSS, TAMMY L
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:CARLOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 WINDER HWY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1328
Mailing Address - Country:US
Mailing Address - Phone:770-682-0213
Mailing Address - Fax:770-682-4371
Practice Address - Street 1:2580 WINDER HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1328
Practice Address - Country:US
Practice Address - Phone:770-682-0213
Practice Address - Fax:770-682-4371
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist