Provider Demographics
NPI:1114111622
Name:COUMOUNDOUROS, TARA BETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:BETH
Last Name:COUMOUNDOUROS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:BETH
Other - Last Name:CREEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1080 ORCHARD CT
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1925
Mailing Address - Country:US
Mailing Address - Phone:412-480-2062
Mailing Address - Fax:
Practice Address - Street 1:1003 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1704
Practice Address - Country:US
Practice Address - Phone:517-265-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039044183500000X
PARP441142183500000X
TN0000027103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist