Healthcare Provider Details

I. General information

NPI: 1902423346
Provider Name (Legal Business Name): TARA MAGOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 S DORSET RD
TROY OH
45373-4705
US

IV. Provider business mailing address

240 SADDLEBROOK RUN
SPRINGFIELD OH
45502-8415
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-2725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03338005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: