Provider Demographics
NPI:1336503325
Name:YORK, TAMMY (DPH)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1001
Mailing Address - Country:US
Mailing Address - Phone:918-683-0135
Mailing Address - Fax:847-396-3002
Practice Address - Street 1:4 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1001
Practice Address - Country:US
Practice Address - Phone:918-683-0135
Practice Address - Fax:847-396-3002
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10235183500000X
KS1-14668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist