Healthcare Provider Details

I. General information

NPI: 1487878807
Provider Name (Legal Business Name): TARA ASHLOCK ANDERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MCARTHUR AVENUE
CELINA TN
38551
US

IV. Provider business mailing address

466 BIG DOG HOLW
CELINA TN
38551-2500
US

V. Phone/Fax

Practice location:
  • Phone: 931-243-6337
  • Fax: 931-243-6336
Mailing address:
  • Phone: 931-644-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000023900
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: