Provider Demographics
NPI:1093157711
Name:HEGE, TARA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:MARIE
Last Name:HEGE
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 1:215 N PINE ST
Mailing Address - Street 2:UNIT 3208
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2080
Mailing Address - Country:US
Mailing Address - Phone:717-360-5032
Mailing Address - Fax:
Practice Address - Street 1:1320 W D ST STE 6
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3560
Practice Address - Country:US
Practice Address - Phone:336-838-5194
Practice Address - Fax:336-838-3393
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist