Provider Demographics
NPI:1265033682
Name:JAMES, TARA TUTOR
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:TUTOR
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 COTTON ACRES
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-8559
Mailing Address - Country:US
Mailing Address - Phone:662-509-0000
Mailing Address - Fax:
Practice Address - Street 1:100 MCCORD RD
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-6245
Practice Address - Country:US
Practice Address - Phone:662-489-5421
Practice Address - Fax:662-489-7424
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-11928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist