Provider Demographics
NPI:1003634544
Name:HUMBERT, TARA (PHARMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HUMBERT
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 1:1762 ALPHON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-4534
Mailing Address - Country:US
Mailing Address - Phone:612-281-3677
Mailing Address - Fax:
Practice Address - Street 1:2 OAKRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318
Practice Address - Country:US
Practice Address - Phone:952-513-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist