Provider Demographics
NPI:1649327768
Name:GRIESER, TARA LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:GRIESER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:MCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6427 PINCHERRY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1231 FRENCH RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4808
Practice Address - Country:US
Practice Address - Phone:716-668-3434
Practice Address - Fax:716-668-4904
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049991183500000X
MI5302034547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist