Provider Demographics
NPI:1629392170
Name:RUSTIN, TAMMY W (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:W
Last Name:RUSTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1441 EATONTON RD
Mailing Address - Street 2:INGLES PHARMACY #444
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650
Mailing Address - Country:US
Mailing Address - Phone:706-342-3119
Mailing Address - Fax:706-342-3628
Practice Address - Street 1:1441 EATONTON RD
Practice Address - Street 2:INGLES PHARMACY #444
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650
Practice Address - Country:US
Practice Address - Phone:706-342-3119
Practice Address - Fax:706-342-3628
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA016347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist