Provider Demographics
NPI:1720347198
Name:OKEEFFE, TARA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:OKEEFFE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19637 SUNSHINE WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1981
Mailing Address - Country:US
Mailing Address - Phone:541-241-0021
Mailing Address - Fax:
Practice Address - Street 1:210 SW CENTURY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1958
Practice Address - Country:US
Practice Address - Phone:541-389-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6582OtherSTATE PHARMACISTS LICENSE