Provider Demographics
NPI:1255961231
Name:UPSHAW, TAMI
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LYNN
Other - Last Name:UPSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:781 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3029
Mailing Address - Country:US
Mailing Address - Phone:770-823-5611
Mailing Address - Fax:
Practice Address - Street 1:781 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3029
Practice Address - Country:US
Practice Address - Phone:843-249-9967
Practice Address - Fax:843-280-3643
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC423161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist