Healthcare Provider Details

I. General information

NPI: 1265033682
Provider Name (Legal Business Name): TARA TUTOR JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MCCORD RD
PONTOTOC MS
38863-6245
US

IV. Provider business mailing address

410 COTTON ACRES
PONTOTOC MS
38863-8559
US

V. Phone/Fax

Practice location:
  • Phone: 662-489-5421
  • Fax: 662-489-7424
Mailing address:
  • Phone: 662-509-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-11928
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: