Provider Demographics
NPI:1487878807
Name:ANDERSON, TARA ASHLOCK (PHARMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ASHLOCK
Last Name:ANDERSON
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 1:466 BIG DOG HOLW
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-2500
Mailing Address - Country:US
Mailing Address - Phone:931-644-6300
Mailing Address - Fax:
Practice Address - Street 1:151 MCARTHUR AVENUE
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551
Practice Address - Country:US
Practice Address - Phone:931-243-6337
Practice Address - Fax:931-243-6336
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000023900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000023900OtherPHARMACIS LISCENSE NUMBER