Provider Demographics
NPI:1780251744
Name:BROTHERS, TAMERA LEA (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:LEA
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 CARLAND RD
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9349
Mailing Address - Country:US
Mailing Address - Phone:989-324-1713
Mailing Address - Fax:
Practice Address - Street 1:681 N MAIN
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9704
Practice Address - Country:US
Practice Address - Phone:517-625-3322
Practice Address - Fax:517-625-5092
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303010841183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician