Provider Demographics
NPI:1720644636
Name:MITTERER, TAMARA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:MITTERER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E HIGHWAY 246 # 3
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9654
Mailing Address - Country:US
Mailing Address - Phone:805-693-1132
Mailing Address - Fax:805-693-1707
Practice Address - Street 1:218 E HIGHWAY 246 # 3
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9654
Practice Address - Country:US
Practice Address - Phone:805-693-1132
Practice Address - Fax:805-683-1707
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist