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General NPI Number Information
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NPI Number | 1538416730
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Entity Type | Individual
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Provider Name | ATHENA MARIE TATE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 2201 EDGEWATER DR
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City | ORLANDO
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State | FL
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Zip | 32804-5319
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Country | US
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Telephone | 407-425-8623
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Fax | 407-843-7604
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Provider Business Mailing Address
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Address Line | 2201 EDGEWATER DR
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City | ORLANDO
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State | FL
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Zip | 32804-5319
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Country | US
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Telephone | 407-425-8623
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Fax | 407-843-7604
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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 | 52641
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License Number State | TX
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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 | 0202213204
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License Number State | VA
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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 | 13787
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 54110
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License Number State | FL
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