Provider Demographics
NPI:1306287768
Name:KALTON, TARA (PHARMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:KALTON
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 1:12455 W MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5004
Mailing Address - Country:US
Mailing Address - Phone:623-238-4757
Mailing Address - Fax:
Practice Address - Street 1:12455 W MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-5004
Practice Address - Country:US
Practice Address - Phone:623-238-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist