Provider Demographics
NPI:1629664586
Name:HADEN, TASHA F (PHARMD)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:F
Last Name:HADEN
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:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482-0120
Mailing Address - Country:US
Mailing Address - Phone:601-758-4243
Mailing Address - Fax:601-758-4999
Practice Address - Street 1:50 WAGON TRL
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482-5071
Practice Address - Country:US
Practice Address - Phone:601-408-6510
Practice Address - Fax:601-758-4999
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist