Provider Demographics
NPI:1558799312
Name:MCCOLLUM, TAMARA DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DEAN
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HARBOUR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SC
Mailing Address - Zip Code:29676-4513
Mailing Address - Country:US
Mailing Address - Phone:864-704-7910
Mailing Address - Fax:
Practice Address - Street 1:7 HARBOUR VIEW DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SC
Practice Address - Zip Code:29676-4513
Practice Address - Country:US
Practice Address - Phone:864-704-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist