Provider Demographics
NPI:1578187159
Name:HENSLEY, TARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HENSLEY
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 1:971 WATERFORD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3234
Mailing Address - Country:US
Mailing Address - Phone:307-258-3519
Mailing Address - Fax:
Practice Address - Street 1:971 WATERFORD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-3234
Practice Address - Country:US
Practice Address - Phone:307-258-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist