Provider Demographics
NPI:1912594177
Name:DUCHINE, TAMARA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:DUCHINE
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 1:51280 COVESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4225
Mailing Address - Country:US
Mailing Address - Phone:574-292-3464
Mailing Address - Fax:
Practice Address - Street 1:7355 HERITAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5643
Practice Address - Country:US
Practice Address - Phone:574-807-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017599A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist