Provider Demographics
NPI:1518362177
Name:TAMURA, CONNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:TAMURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26603 72ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6273
Mailing Address - Country:US
Mailing Address - Phone:360-629-5520
Mailing Address - Fax:360-629-5538
Practice Address - Street 1:26603 72ND AVE NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6273
Practice Address - Country:US
Practice Address - Phone:360-629-5520
Practice Address - Fax:360-629-5538
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist