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General NPI Number Information
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NPI Number | 1003634544
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Entity Type | Individual
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Provider Name | TARA HUMBERT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 2 OAKRIDGE DRIVE
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City | CHASKA
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State | MN
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Zip | 55318
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Country | US
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Telephone | 952-513-2831
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Fax |
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Provider Business Mailing Address
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Address Line | 1762 ALPHON DR
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City | VICTORIA
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State | MN
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Zip | 55386-4534
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Country | US
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Telephone | 612-281-3677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 117227
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License Number State | MN
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