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Individual

TARA MISTELL DOUGLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
279 UNDERPASS DR, ONEIDA, TN 37841-5885
(423) 569-7800
Mailing address
749 BART GRANT HOLLOW RD, WINFIELD, TN 37892-3664

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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