Provider Demographics
NPI:1679935332
Name:BIRD, TAMMY B (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:B
Last Name:BIRD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:B
Other - Last Name:BRODIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:617 W HAVASUPAI RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1513
Mailing Address - Country:US
Mailing Address - Phone:928-600-7273
Mailing Address - Fax:
Practice Address - Street 1:617 W HAVASUPAI RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1513
Practice Address - Country:US
Practice Address - Phone:928-600-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0143641835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist