MEDICARE: TARA CARFREY CPHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	S9Z2P2Z2

General Provider Information

NPI Number	:	1053901777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA CARFREY CPHT

Provider Business Mailing Address
First Line	:	121 E CITY LINE AVE
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 E CITY LINE AVE
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2448
Country	:	US
Telephone Number	:	610-667-7051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	01/26/2021

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