Provider Demographics
NPI:1538416730
Name:TATE, ATHENA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:MARIE
Last Name:TATE
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 1:2201 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5319
Mailing Address - Country:US
Mailing Address - Phone:407-425-8623
Mailing Address - Fax:407-843-7604
Practice Address - Street 1:2201 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5319
Practice Address - Country:US
Practice Address - Phone:407-425-8623
Practice Address - Fax:407-843-7604
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52641183500000X
VA0202213204183500000X
SC13787183500000X
FL54110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist