Provider Demographics
NPI:1871187963
Name:DEAN, TAMMY JANICE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JANICE
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W CHAPMAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-9068
Mailing Address - Country:US
Mailing Address - Phone:940-458-4448
Mailing Address - Fax:940-458-3008
Practice Address - Street 1:801 W CHAPMAN DR STE 100
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-9068
Practice Address - Country:US
Practice Address - Phone:940-458-4448
Practice Address - Fax:940-458-3008
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35008333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy