Provider Demographics
NPI:1073696365
Name:TARA PHARMACY SE LLC
Entity type:Organization
Organization Name:TARA PHARMACY SE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:COX
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:601-664-1664
Mailing Address - Street 1:211 SUMMIT PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4751
Mailing Address - Country:US
Mailing Address - Phone:205-916-2267
Mailing Address - Fax:
Practice Address - Street 1:211 SUMMIT PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-4751
Practice Address - Country:US
Practice Address - Phone:205-916-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1127373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0133493OtherNCPDP NUMBER
AL100003676Medicaid