Provider Demographics
NPI:1437471273
Name:BURKHART, TARA K (RPH)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:K
Last Name:BURKHART
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 THREADGRASS RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5761
Mailing Address - Country:US
Mailing Address - Phone:505-898-9354
Mailing Address - Fax:
Practice Address - Street 1:1005 THREADGRASS RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5761
Practice Address - Country:US
Practice Address - Phone:505-898-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019258A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist