Healthcare Provider Details

I. General information

NPI: 1659662195
Provider Name (Legal Business Name): TARA PATRICE ANTHONY R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PHILADELPHIA AVE
READING PA
19607-2769
US

IV. Provider business mailing address

670 PHILADELPHIA AVE
READING PA
19607-2769
US

V. Phone/Fax

Practice location:
  • Phone: 610-777-8278
  • Fax:
Mailing address:
  • Phone: 610-777-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP034595L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: