Healthcare Provider Details

I. General information

NPI: 1063549368
Provider Name (Legal Business Name): TARA PHARMACY SE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SUMMIT PKWY SUITE 112
HOMEWOOD AL
35209-4751
US

IV. Provider business mailing address

211 SUMMIT PKWY SUITE 112
HOMEWOOD AL
35209-4751
US

V. Phone/Fax

Practice location:
  • Phone: 205-916-2267
  • Fax: 205-916-0877
Mailing address:
  • Phone: 205-916-2267
  • Fax: 205-916-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number112737
License Number StateAL

VIII. Authorized Official

Name: MR. NORBERT A BENNETT
Title or Position: CEO
Credential:
Phone: 716-662-4955