Provider Demographics
NPI:1336865203
Name:ALLY, TAMARA LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LOUISE
Last Name:ALLY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-2106
Mailing Address - Country:US
Mailing Address - Phone:817-946-7872
Mailing Address - Fax:
Practice Address - Street 1:1300 N HOBART ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-4122
Practice Address - Country:US
Practice Address - Phone:806-665-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist