MEDICARE: BRYAN DOUGLAS TARR 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	15034	NV

General Provider Information

NPI Number	:	1063794899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN DOUGLAS TARR PHARMD

Provider Business Mailing Address
First Line	:	7846 ABALONE BAY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6117
Country	:	US
Telephone Number	:	702-255-5490
Fax Number	:

Provider Business Practice Location Address
First Line	:	8633 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5406
Country	:	US
Telephone Number	:	702-383-9660
Fax Number	:

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

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/19/2011

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