Provider Demographics
NPI:1558646505
Name:SHOCKLEY, TAMMIE ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMIE
Middle Name:ANNE
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 OLD US 231 S
Mailing Address - Street 2:WALGREENS 10974
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909
Mailing Address - Country:US
Mailing Address - Phone:219-776-7008
Mailing Address - Fax:765-477-6480
Practice Address - Street 1:2800 OLD US 231 S
Practice Address - Street 2:WALGREENS 10974
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909
Practice Address - Country:US
Practice Address - Phone:765-471-1013
Practice Address - Fax:765-477-6480
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN260202001A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist