Provider Demographics
NPI:1912284910
Name:CARPENTER, TARA ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:ELIZABETH
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ELIZABETH
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:14380 CONCERT AVE
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65255-9719
Mailing Address - Country:US
Mailing Address - Phone:573-999-5051
Mailing Address - Fax:
Practice Address - Street 1:14380 CONCERT AVE
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65255
Practice Address - Country:US
Practice Address - Phone:573-999-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004032888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist