Provider Demographics
NPI:1629202932
Name:KAUFMAN, TAMARA L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:L
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S 2ND ST
Mailing Address - Street 2:PO BOX 429
Mailing Address - City:ELGIN
Mailing Address - State:NE
Mailing Address - Zip Code:68636-4409
Mailing Address - Country:US
Mailing Address - Phone:402-843-5555
Mailing Address - Fax:
Practice Address - Street 1:112 S 2ND ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:NE
Practice Address - Zip Code:68636-4409
Practice Address - Country:US
Practice Address - Phone:402-843-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025557800Medicaid
NE0926780001Medicare PIN