Provider Demographics
NPI:1124312970
Name:WADE, TAMARA MARKL (PHARMD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARKL
Last Name:WADE
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 1:3970 SW ARCHER RD
Mailing Address - Street 2:TARGET T-0687
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2342
Mailing Address - Country:US
Mailing Address - Phone:352-377-0939
Mailing Address - Fax:
Practice Address - Street 1:3970 SW ARCHER RD
Practice Address - Street 2:TARGET T-0687
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2342
Practice Address - Country:US
Practice Address - Phone:352-377-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist