Healthcare Provider Details

I. General information

NPI: 1578010732
Provider Name (Legal Business Name): TARA DOLEMAN PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 LAWRENCEVILLE HWY
DECATUR GA
30033-3239
US

IV. Provider business mailing address

2545 LAWRENCEVILLE HWY
DECATUR GA
30033-3239
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-1950
  • Fax:
Mailing address:
  • Phone: 404-321-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH017952
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: