Mack, Tiasara

Mack, Tiasara is an individual health care provider with primary practice located at 1832 Kempsville Rd , Virginia Beach VA 23464-6861. She recently has only one registered license in Pharmacy Service Providers / Geriatric, which is considered as her primary health care specialty. Mack, Tiasara can be contacted via phone (757) 278-2573.

Contact Information

Primary practice address
1832 Kempsville Rd Virginia Beach VA 23464-6861
Phone: (757) 278-2573
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Geriatric 1835G0303X 0202215182 Virginia

Profile Details

NPI number 1699377135
LBN Legal business name Mack, Tiasara
Credentials PHARMD
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2020
Last updated Nov 10th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699377135 NPPES
Virginia Other 0202215182 VIRGINIA BOARD OF PHARMACY LICENSE NUMBER

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