Provider Demographics
NPI:1578885869
Name:GRIFFIN, TAMARA MCMACKIN (RPH)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MCMACKIN
Last Name:GRIFFIN
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 1:516 S SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2825
Mailing Address - Country:US
Mailing Address - Phone:704-364-2865
Mailing Address - Fax:
Practice Address - Street 1:4400 GOLF ACRES DR
Practice Address - Street 2:BLDG J SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5990
Practice Address - Country:US
Practice Address - Phone:704-512-7628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist