Provider Demographics
NPI:1073898383
Name:TAGUE, AIMEE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:L
Last Name:TAGUE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2416
Mailing Address - Country:US
Mailing Address - Phone:508-222-7779
Mailing Address - Fax:508-222-0573
Practice Address - Street 1:196 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2416
Practice Address - Country:US
Practice Address - Phone:508-222-7779
Practice Address - Fax:508-222-0573
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist