Provider Demographics
NPI:1962504571
Name:HENRY, TARA BENJAMIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:BENJAMIN
Last Name:HENRY
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 1:5010 BRANDED OAKS CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-8834
Mailing Address - Country:US
Mailing Address - Phone:850-878-0191
Mailing Address - Fax:
Practice Address - Street 1:1607 SAINT JAMES CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5352
Practice Address - Country:US
Practice Address - Phone:850-878-0191
Practice Address - Fax:850-878-8900
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS333731835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy