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General NPI Number Information
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NPI Number | 1154461028
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Entity Type | Individual
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Provider Name | TARAH MICHELLE STANDRIDGE PHARM D
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 929 NEW HIGHWAY 68
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City | SWEETWATER
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State | TN
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Zip | 37874-2726
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Country | US
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Telephone | 423-351-1277
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Fax | 423-351-1547
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Provider Business Mailing Address
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Address Line | 195 VINEGAR RIDGE RD
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City | MADISONVILLE
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State | TN
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Zip | 37354-6400
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Country | US
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Telephone | 865-335-0462
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Fax | 423-351-1547
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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 | 27047
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License Number State | TN
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