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General NPI Number Information
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NPI Number | 1114111622
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Entity Type | Individual
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Provider Name | TARA BETH COUMOUNDOUROS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 1003 N MAIN ST
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City | ADRIAN
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State | MI
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Zip | 49221-1704
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Country | US
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Telephone | 517-265-1565
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 ORCHARD CT
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City | ADRIAN
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State | MI
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Zip | 49221-1925
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Country | US
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Telephone | 412-480-2062
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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 | 5302039044
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP441142
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0000027103
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License Number State | TN
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