Active NPI
Tamara Bodagh
- Pharmacist
- Saint Clair Shores, MI
National Provider Identifier
1447902259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302413739
- Practice address
- 22801 Harper Ave
Saint Clair Shores, MI 48080-1848 - Phone
- (586) 800-5190
- NPI assigned
- Jan 23, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302413739 | MI | Primary |
Addresses
Primary practice location
22801 Harper Ave
Saint Clair Shores, MI 48080-1848
Mailing address
1610 Jackson Dr
Troy, MI 48083-2037
Phone (248) 796-1674
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302413739 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642896000000",
"number": "1447902259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1610 JACKSON DR",
"city": "TROY",
"state": "MI",
"postal_code": "480832037",
"telephone_number": "248-796-1674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22801 HARPER AVE",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480801848",
"telephone_number": "586-800-5190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODAGH",
"first_name": "TAMARA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-23",
"last_updated": "2022-01-23",
"certification_date": "2022-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302413739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clair Shores, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.