| NPI | 1649327768 |
|---|---|
| Former Name | TARA LYNN MCLELLAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049991) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034547) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-07-08 |