Provider Demographics
NPI:1134332562
Name:BOOTH, TAMME (RPH)
Entity type:Individual
Prefix:
First Name:TAMME
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TAMME
Other - Middle Name:
Other - Last Name:WILTENMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:9826 BLUE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-1938
Mailing Address - Country:US
Mailing Address - Phone:916-208-6075
Mailing Address - Fax:
Practice Address - Street 1:1850 PRAIRIE CITY RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9518
Practice Address - Country:US
Practice Address - Phone:916-608-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36453OtherPHARMACIST LICENSE
VA0202207233OtherPHARMACIST LICENSE
AZ14656OtherPHARMACIST LICENSE
CA45043OtherPHARMACIST LICENSE
LA14178OtherPHARMACIST LICENSE