Provider Demographics
NPI:1639766256
Name:CLARKE, TARA ELIZABETH
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:CLARKE
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 1:2325 KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4625
Mailing Address - Country:US
Mailing Address - Phone:302-753-2512
Mailing Address - Fax:
Practice Address - Street 1:1050 BRANDYWINE PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1492
Practice Address - Country:US
Practice Address - Phone:302-478-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician