Provider Demographics
NPI:1417675414
Name:SEPULVEDA, TAMMY LEE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEE
Last Name:SEPULVEDA
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 1:601 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1347
Mailing Address - Country:US
Mailing Address - Phone:254-699-8810
Mailing Address - Fax:254-699-9206
Practice Address - Street 1:601 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1347
Practice Address - Country:US
Practice Address - Phone:254-699-8810
Practice Address - Fax:254-699-9206
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205011183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3012360Other3012360