Provider Demographics
NPI:1891069340
Name:GENDRON, TARA G (RPH)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:G
Last Name:GENDRON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6825
Mailing Address - Country:US
Mailing Address - Phone:603-436-0562
Mailing Address - Fax:603-427-6155
Practice Address - Street 1:161 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6825
Practice Address - Country:US
Practice Address - Phone:603-436-0562
Practice Address - Fax:603-427-6155
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1354183500000X
ME3999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist