Individual
MRS. TARA LEE COSTA-WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
580 METACOM AVE, BRISTOL, RI 02809-5182
(401) 253-2723
(401) 253-3980
Mailing address
580 METACOM AVE, BRISTOL, RI 02809-5182
(401) 253-2723
(401) 253-3980
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH03692
RI
Other
Enumeration date
08/12/2008
Last updated
08/12/2008
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