Provider Demographics
NPI:1578816351
Name:WILLIAMS, TAMARA ANN (RPH, CGP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 GROVE AVE
Mailing Address - Street 2:#917
Mailing Address - City:WASHINGTON GROVE
Mailing Address - State:MD
Mailing Address - Zip Code:20880-2040
Mailing Address - Country:US
Mailing Address - Phone:301-869-8541
Mailing Address - Fax:
Practice Address - Street 1:213 GROVE AVE
Practice Address - Street 2:#917
Practice Address - City:WASHINGTON GROVE
Practice Address - State:MD
Practice Address - Zip Code:20880-2040
Practice Address - Country:US
Practice Address - Phone:301-869-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205616183500000X
MD12569183500000X
DCPH100000161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist