Provider Demographics
NPI:1831671270
Name:ENGEL, TARA M
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:ENGEL
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 1:19 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:LARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-709-7058
Mailing Address - Fax:
Practice Address - Street 1:241 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235
Practice Address - Country:US
Practice Address - Phone:610-377-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI012352183500000X
PARP452563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist