Provider Demographics
NPI:1467720383
Name:SHEAR, TARA LEA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LEA
Last Name:SHEAR
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 1:977 HIGHWAY 98 E
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2801
Mailing Address - Country:US
Mailing Address - Phone:850-650-4538
Mailing Address - Fax:850-650-9579
Practice Address - Street 1:977 HIGHWAY 98 E
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2801
Practice Address - Country:US
Practice Address - Phone:850-650-4538
Practice Address - Fax:850-650-9579
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist