Provider Demographics
NPI:1740956986
Name:PAULEY, TAMYA KRISTEEN
Entity type:Individual
Prefix:DR
First Name:TAMYA
Middle Name:KRISTEEN
Last Name:PAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10826 GLOWING HEARTH WAY
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770-6001
Mailing Address - Country:US
Mailing Address - Phone:240-515-5918
Mailing Address - Fax:
Practice Address - Street 1:7830 WORMANS MILL RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3034
Practice Address - Country:US
Practice Address - Phone:240-515-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD17724OtherPHARMACIST REGISTRAN LICIENSE