Provider Demographics
NPI:1336642966
Name:THOMPSON, TAMARA DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DAWN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:DAWN
Other - Last Name:TEEL-THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:29038 RIVER RUN LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-3908
Mailing Address - Country:US
Mailing Address - Phone:909-674-5326
Mailing Address - Fax:
Practice Address - Street 1:1120 W LA PALMA AVE STE 1
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2820
Practice Address - Country:US
Practice Address - Phone:714-776-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist