Provider Demographics
NPI:1104426246
Name:MUKHTAR, TARIG M
Entity type:Individual
Prefix:
First Name:TARIG
Middle Name:M
Last Name:MUKHTAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 MCGREEVY DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8573
Mailing Address - Country:US
Mailing Address - Phone:614-353-3558
Mailing Address - Fax:
Practice Address - Street 1:85 RIVER TRCE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2686
Practice Address - Country:US
Practice Address - Phone:740-774-2343
Practice Address - Fax:740-774-1027
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist