Provider Demographics
NPI:1407156995
Name:SUBLETTE, TAMI (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:
Last Name:SUBLETTE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20710 KEOKUK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6620
Mailing Address - Country:US
Mailing Address - Phone:612-354-5934
Mailing Address - Fax:612-354-5928
Practice Address - Street 1:20710 KEOKUK AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6620
Practice Address - Country:US
Practice Address - Phone:612-354-5934
Practice Address - Fax:612-354-5928
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120749183500000X
AZ13709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist