Provider Demographics
NPI:1770821258
Name:OLIVER, TAMI C (RPH)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:C
Last Name:OLIVER
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 1:3070 N MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2756
Mailing Address - Country:US
Mailing Address - Phone:678-269-6476
Mailing Address - Fax:
Practice Address - Street 1:3070 N MAIN ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2756
Practice Address - Country:US
Practice Address - Phone:678-269-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist