Provider Demographics
NPI:1073853933
Name:KERBAGE, TAREK JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TAREK
Middle Name:JOHN
Last Name:KERBAGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HABERSHAM COUNTY SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-3412
Mailing Address - Country:US
Mailing Address - Phone:706-778-8099
Mailing Address - Fax:706-778-8100
Practice Address - Street 1:199 HABERSHAM COUNTY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-3412
Practice Address - Country:US
Practice Address - Phone:706-778-8099
Practice Address - Fax:706-778-8100
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34598183500000X
GARPH028237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist