Provider Demographics
NPI:1043587025
Name:HUBERT, TARA RENEE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:RENEE
Last Name:HUBERT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CROMER AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2910
Mailing Address - Country:US
Mailing Address - Phone:330-493-9404
Mailing Address - Fax:
Practice Address - Street 1:3100 CROMER AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2910
Practice Address - Country:US
Practice Address - Phone:330-493-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03327106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist