Provider Demographics
NPI:1174173140
Name:LONG, TAMMY TYNDALL (RPH)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:TYNDALL
Last Name:LONG
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 1:1412 VERGELAND DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7548
Mailing Address - Country:US
Mailing Address - Phone:910-624-2025
Mailing Address - Fax:
Practice Address - Street 1:217 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1533
Practice Address - Country:US
Practice Address - Phone:910-865-4135
Practice Address - Fax:910-865-3000
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist