Provider Demographics
NPI:1306820345
Name:TARARA PHARMACY, INC.
Entity type:Organization
Organization Name:TARARA PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORTEGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-545-7561
Mailing Address - Street 1:1160 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1034
Mailing Address - Country:US
Mailing Address - Phone:305-545-7561
Mailing Address - Fax:305-545-0505
Practice Address - Street 1:1160 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1034
Practice Address - Country:US
Practice Address - Phone:305-545-7561
Practice Address - Fax:305-545-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH18483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102105200Medicaid
FLPH0001848OtherSTATE LICENSE NUMBER
FLPH0001848OtherSTATE LICENSE NUMBER