Provider Demographics
NPI:1811444086
Name:NALLEY, TARA (PHARMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NALLEY
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 1:134 MOUNTAINSIDE VILLAGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-8694
Mailing Address - Country:US
Mailing Address - Phone:706-253-3100
Mailing Address - Fax:706-253-3101
Practice Address - Street 1:134 MOUNTAINSIDE VILLAGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-8694
Practice Address - Country:US
Practice Address - Phone:706-253-3100
Practice Address - Fax:706-253-3101
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0199471835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology