MEDICARE: TARINA ASHA JAIN COBURN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	16608	AL

General Provider Information

NPI Number	:	1023389665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARINA ASHA JAIN COBURN PHARMD

Provider Business Mailing Address
First Line	:	1127 6TH AVE SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4009
Country	:	US
Telephone Number	:	256-355-4495
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 6TH AVE SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4009
Country	:	US
Telephone Number	:	256-355-4495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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