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General NPI Number Information
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NPI Number | 1205112851
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Entity Type | Individual
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Provider Name | TARA ELIZABETH KOEHLER PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 2801 WASHINGTON RD
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City | AUGUSTA
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State | GA
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Zip | 30909-2111
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Country | US
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Telephone | 706-731-7333
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Fax | 706-731-7320
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Provider Business Mailing Address
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Address Line | 4541 GLASTONBURY DR
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City | EVANS
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State | GA
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Zip | 30809-8216
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Country | US
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Telephone | 706-869-8645
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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 | 13174
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License Number State | SC
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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 | 019932
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License Number State | GA
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