Healthcare Provider Details

I. General information

NPI: 1871005389
Provider Name (Legal Business Name): TARA DANIELLE PERKINS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 WOODMAN DR
DAYTON OH
45431-1423
US

IV. Provider business mailing address

311 JEFFERSON AVE APT 4C
URBANA OH
43078-1754
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-1901
  • Fax:
Mailing address:
  • Phone: 937-926-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03337704
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: