Provider Demographics
NPI:1689998411
Name:PFUND, TARA L
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:PFUND
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 1:1027 NW GOODWIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8750
Mailing Address - Country:US
Mailing Address - Phone:503-476-6118
Mailing Address - Fax:
Practice Address - Street 1:1027 NW GOODWIN ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8750
Practice Address - Country:US
Practice Address - Phone:503-476-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60101469183500000X, 1835P0018X
ORRPH0011879183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist