Provider Demographics
NPI:1649541186
Name:GRUESER, TAMARA LYNNE (RPH)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNNE
Last Name:GRUESER
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 1:706 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-1224
Mailing Address - Country:US
Mailing Address - Phone:740-992-6491
Mailing Address - Fax:740-992-3811
Practice Address - Street 1:706 W MAIN ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-1224
Practice Address - Country:US
Practice Address - Phone:740-992-6491
Practice Address - Fax:740-992-3811
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03320030183500000X
WVRP0005451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist