Provider Demographics
NPI:1598065237
Name:BUMGARNER, TAMMY J (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:BUMGARNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 NININGER RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1056
Mailing Address - Country:US
Mailing Address - Phone:651-480-4261
Mailing Address - Fax:651-480-4266
Practice Address - Street 1:1175 NININGER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1056
Practice Address - Country:US
Practice Address - Phone:651-480-4261
Practice Address - Fax:651-480-4266
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115801183500000X
WAPH 00018577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist