Healthcare Provider Details

I. General information

NPI: 1194820654
Provider Name (Legal Business Name): TARA E SCHAFERS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S MAIN ST
TRIPP SD
57376-2107
US

IV. Provider business mailing address

512 S MAIN ST
TRIPP SD
57376-2107
US

V. Phone/Fax

Practice location:
  • Phone: 605-589-4418
  • Fax: 605-589-4428
Mailing address:
  • Phone: 605-935-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4939
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: