Provider Demographics
NPI:1366875254
Name:TARDIF, CAROLYN SYLVIA (PHARMD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SYLVIA
Last Name:TARDIF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HUCKINS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3928
Mailing Address - Country:US
Mailing Address - Phone:207-891-8711
Mailing Address - Fax:
Practice Address - Street 1:61 UNION ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5475
Practice Address - Country:US
Practice Address - Phone:207-753-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist