MEDICARE: TARA MCINTYRE 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	68851	CA
2	183500000X	Pharmacist	016082	KY

General Provider Information

NPI Number	:	1427473040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MCINTYRE PHARMD

Provider Business Mailing Address
First Line	:	2293 RIVER OAKS BLVD
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-9194
Country	:	US
Telephone Number	:	530-634-9980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2293 RIVER OAKS BLVD
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-9194
Country	:	US
Telephone Number	:	530-634-9980
Fax Number	:

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

Provider Enumeration Date	:	02/19/2014
Last Update Date	:	02/19/2014

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Directions to “ TARA MCINTYRE PHARMD” Practice Location

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