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Individual

DR. TIASARA MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
1832 KEMPSVILLE RD, VIRGINIA BEACH, VA 23464-6861
(757) 278-2573
Mailing address
1872 SOMERTON PL, VIRGINIA BEACH, VA 23464-6944

Taxonomy

Speciality
Code
Description
License number
State
1835G0303X
Geriatric Pharmacist
Primary
0202215182
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0202215182
VIRGINIA BOARD OF PHARMACY LICENSE NUMBER
VA
Enumeration date
11/10/2020
Last updated
11/10/2020
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