Provider Demographics
NPI:1720422702
Name:TARANTOLA, JAMES S (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:S
Last Name:TARANTOLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILDERNESS RUN
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136
Mailing Address - Country:US
Mailing Address - Phone:386-439-3724
Mailing Address - Fax:
Practice Address - Street 1:10 WILDERNESS RUN
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-4925
Practice Address - Country:US
Practice Address - Phone:386-439-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1835000000X183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist