Provider Demographics
NPI:1205252251
Name:SCAIFE, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SCAIFE
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:PO BOX 370
Mailing Address - Street 2:115 W. JESSIE ST
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-0370
Mailing Address - Country:US
Mailing Address - Phone:507-864-2153
Mailing Address - Fax:507-864-2413
Practice Address - Street 1:115 W JESSIE ST
Practice Address - Street 2:
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971-8837
Practice Address - Country:US
Practice Address - Phone:507-864-2153
Practice Address - Fax:507-864-2413
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114805183500000X
WI16627-40183500000X
GA015411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist