Provider Demographics
NPI:1730368473
Name:WESTCOTT, TAMARA (RPH)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WESTCOTT
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 1:1250 UPPER FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1068
Mailing Address - Country:US
Mailing Address - Phone:607-723-8291
Mailing Address - Fax:607-651-9992
Practice Address - Street 1:1250 UPPER FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1068
Practice Address - Country:US
Practice Address - Phone:607-723-8291
Practice Address - Fax:607-651-9992
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00578432Medicaid