Provider Demographics
NPI:1407450562
Name:WADDINGTON, TAMARA LYNN
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:WADDINGTON
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 1:1216 OLD MILL LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-9605
Mailing Address - Country:US
Mailing Address - Phone:765-404-2989
Mailing Address - Fax:
Practice Address - Street 1:201 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-2410
Practice Address - Country:US
Practice Address - Phone:765-659-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017807A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist