Provider Demographics
NPI:1922392745
Name:GABARD, TAMMY G
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:G
Last Name:GABARD
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 1:189 HICKORY TREE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-8759
Mailing Address - Country:US
Mailing Address - Phone:336-764-5310
Mailing Address - Fax:
Practice Address - Street 1:189 HICKORY TREE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-8759
Practice Address - Country:US
Practice Address - Phone:336-764-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist