Provider Demographics
NPI:1871674853
Name:BRUMBAUGH, TAMMY STANFIELD
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:STANFIELD
Last Name:BRUMBAUGH
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 1:161 MAYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15909-4428
Mailing Address - Country:US
Mailing Address - Phone:814-322-4180
Mailing Address - Fax:
Practice Address - Street 1:1940 WILLIAM PENN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-1609
Practice Address - Country:US
Practice Address - Phone:814-322-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036440R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist