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General NPI Number Information
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NPI Number | 1760090963
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Entity Type | Individual
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Provider Name | TARA OSTRANDER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 4031 GRANGE HALL RD
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City | HOLLY
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State | MI
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Zip | 48442-1938
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Country | US
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Telephone | 248-634-8294
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Fax |
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Provider Business Mailing Address
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Address Line | 1357 GLEN VALLEY DR
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City | HOWELL
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State | MI
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Zip | 48843-6142
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Country | US
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Telephone | 810-599-1129
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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 | 5302412573
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License Number State | MI
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