Individual
TARA MISTELL DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
19006
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19006
STATE OF TENNESSE BOARD OF PHARMACY
TN
Enumeration date
06/12/2017
Last updated
06/12/2017
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