Provider Demographics
NPI:1336435130
Name:SEABOURNE, TAMELA LEE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAMELA
Middle Name:LEE
Last Name:SEABOURNE
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 1:3803 MONONA DR APT 120
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53714-2864
Mailing Address - Country:US
Mailing Address - Phone:530-520-5813
Mailing Address - Fax:
Practice Address - Street 1:4301 LIEN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3608
Practice Address - Country:US
Practice Address - Phone:608-819-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16223-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52667OtherPHARMACIST LICENSE
WI16223-040OtherPHARMACIST LICENSE