Individual
TARA LOAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3601 4TH ST STOP 8162, LUBBOCK, TX 79430-8162
(806) 743-4200
(806) 743-4209
Mailing address
210 N WINSTON AVE # 334, LUBBOCK, TX 79416-1529
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
45289
TX
Other
Enumeration date
01/14/2008
Last updated
01/14/2008
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