Healthcare Provider Details

I. General information

NPI: 1124432679
Provider Name (Legal Business Name): TARA LYNN DUPREE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LAUREL STREET
SUMMIT MS
39666
US

IV. Provider business mailing address

1025 NORTHWOOD DR
SUMMIT MS
39666-9165
US

V. Phone/Fax

Practice location:
  • Phone: 601-465-0500
  • Fax: 601-465-0502
Mailing address:
  • Phone: 601-341-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE08893
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE08893
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71868
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: