Provider Demographics
NPI:1962793109
Name:EL ASSAR, TAREK M
Entity type:Individual
Prefix:MR
First Name:TAREK
Middle Name:M
Last Name:EL ASSAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SHELBURNE SHOPPING PARK
Mailing Address - Street 2:RITE AID # 10326
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7488
Mailing Address - Country:US
Mailing Address - Phone:802-985-0143
Mailing Address - Fax:
Practice Address - Street 1:30 SHELBURNE SHOPPING PARK
Practice Address - Street 2:RITE AID # 10326
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7488
Practice Address - Country:US
Practice Address - Phone:802-985-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0068970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist