Provider Demographics
NPI:1417224353
Name:JOHNSON, TAMBREA LC (PHARMACIST, PTA)
Entity Type:Individual
Prefix:MS
First Name:TAMBREA
Middle Name:LC
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMACIST, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CADDIS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8140
Mailing Address - Country:US
Mailing Address - Phone:803-331-7476
Mailing Address - Fax:
Practice Address - Street 1:1324 GROVE PARK DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-2455
Practice Address - Country:US
Practice Address - Phone:803-536-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1804225200000X
SC43281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant