=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578841847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA STRINGFELLOW RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2011
-----------------------------------------------------
Last Update Date | 08/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 W FRONTAGE RD SUITE A
-----------------------------------------------------
City | LUCEDALE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39452-5836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-947-4941
-----------------------------------------------------
Fax | 601-766-3010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3188 WARD PINEVIEW RD
-----------------------------------------------------
City | LUCEDALE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39452-6213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-766-3007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | T09505
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------