Provider Demographics
NPI:1649594615
Name:FRICKE, TARA L (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:L
Last Name:FRICKE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EMERSON PLZ W
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1826
Mailing Address - Country:US
Mailing Address - Phone:201-262-4999
Mailing Address - Fax:201-262-3870
Practice Address - Street 1:4 EMERSON PLZ W
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1826
Practice Address - Country:US
Practice Address - Phone:201-262-4999
Practice Address - Fax:201-262-3870
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02782500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI0282500OtherPHARMACY LICENSE