Provider Demographics
NPI:1265718910
Name:TENNYSON, PAMELA RENEE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:RENEE
Last Name:TENNYSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PAUL BUNYAN DR NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2435
Mailing Address - Country:US
Mailing Address - Phone:218-333-4032
Mailing Address - Fax:218-333-4035
Practice Address - Street 1:421 PAUL BUNYAN DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2435
Practice Address - Country:US
Practice Address - Phone:218-333-4032
Practice Address - Fax:218-333-4035
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist