Provider Demographics
NPI:1205112851
Name:KOEHLER, TARA ELIZABETH (PHARM D)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 GLASTONBURY DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8216
Mailing Address - Country:US
Mailing Address - Phone:706-869-8645
Mailing Address - Fax:
Practice Address - Street 1:2801 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2111
Practice Address - Country:US
Practice Address - Phone:706-731-7333
Practice Address - Fax:706-731-7320
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13174183500000X
GA019932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist