Healthcare Provider Details

I. General information

NPI: 1093157711
Provider Name (Legal Business Name): TARA MARIE HEGE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W D ST STE 6
NORTH WILKESBORO NC
28659-3560
US

IV. Provider business mailing address

215 N PINE ST UNIT 3208
CHARLOTTE NC
28202-2080
US

V. Phone/Fax

Practice location:
  • Phone: 336-838-5194
  • Fax: 336-838-3393
Mailing address:
  • Phone: 717-360-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: