Provider Demographics
NPI:1760076798
Name:TAGARE, ROSEMARIE DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:DAWN
Last Name:TAGARE
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 1:260 S 500 E APT 326
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3783
Mailing Address - Country:US
Mailing Address - Phone:773-540-4968
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR # A-050
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-213-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051302164183500000X
UT11701493-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist