MRS. TARA LEE COSTA-WALLACE (NPI# 1629224456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629224456 |
| Entity Type | Individual |
| Full Name | MRS. TARA LEE COSTA-WALLACE |
| Credential | PHARMD |
| Practice Address |
580 Metacom Ave Bristol RI 02809-5182 |
| Practice Telephone | 4012532723 |
| Practice Fax Number | 4012533980 |
| Mailing Telephone | 4012532723 |
| Mailing Fax Number | 4012533980 |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2008-08-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | RPH03692 | RI | Pharmacy Service Providers |
| Street Address |
580 METACOM AVE |
| City | BRISTOL |
| State | RI |
| Zip Code | 02809-5182 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417063603 | Raffi Calikyan | Internal Medicine | 580 Metacom Ave, Bristol, RI 02809-5182 | 2006-08-22 |
| 1396268256 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 580 Metacom Ave, Bristol, RI 02809 | 2017-07-24 |
| 1639463938 | Jennifer Lynn Ferreira | Pharmacist | 580 Metacom Ave, Bristol, RI 02809-5182 | 2011-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598246068 | Maryann Bishop | Physical Therapist | 7 Creek Lane, Bristol, RI 02809 | 2018-08-23 |
| 1063913127 | Melanie Hopper Koppelman | Acupuncturist | Harbor Integrative Health, LLC, 60 Poppasquash Road, Bristol, RI 02809 | 2018-02-23 |
| 1871011478 | Ashley Hayes Pereira | Occupational Therapist | 31 Duffield Rd, Bristol, RI 02809 | 2017-09-03 |
| 1447792437 | Marguerite Peruto | Counselor | 10 Wardwell Street, Studio #4, Bristol, RI 02809 | 2016-11-08 |
| 1174829873 | Meghan Elizabeth Martorana | Dietitian, Registered | 685 Metacom Avenue, Bristol, RI 02809 | 2011-01-28 |
| 1881909794 | Hoffmann Chiropractic Inc | Chiropractor | 450 Hope Street, Bristol, RI 02809 | 2010-08-16 |
| 1558555961 | Michael James Allen | Dentist | 36 Bradford Street, Bristol, RI 02809 | 2007-08-29 |
| 1033309141 | Melinda Mary Allaire | Physical Therapist | 2 Ruth Ave, Bristol, RI 02809 | 2007-07-26 |
| 1033240726 | Emily Snow Delconte | Dietitian, Registered | 685 Metacom Ave, Bristol, RI 02809 | 2007-03-07 |
| 1881756203 | Warren Dental Associates Inc | Dentist | 634 Main Street, Warren, RI 02809 | 2006-12-14 |
| Find all providers in zip 02809 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113791 | Jamie Lester | Pharmacist | 21531 Market Ctr, Bristol, VA 24202-1808 | 2020-10-30 |
| 1699281113 | Mythili Tarala | Pharmacist | 54 Bonnie Ct, Bristol, CT 06010-5994 | 2017-12-19 |
| 1750897666 | Ray Mcclellan Massengill IIi | Pharmacist | 15767 Monticello Dr, Bristol, VA 24202-4113 | 2017-12-15 |
| 1740703065 | Robert Christopher Isner Jr. | Pharmacist | 430 N Main St Ste A, Bristol, CT 06010-4117 | 2017-07-18 |
| 1033647755 | Alyssa Emily Capuano | Pharmacist | 2 Betsy Dr, Bristol, RI 02809-4552 | 2017-05-24 |
| 1588103600 | Elizabeth Anne Costello | Pharmacist | 747 Pine Street, Bristol, CT 06010 | 2017-02-22 |
| 1215324611 | George Le | Pharmacist | 90 Maheu St, Bristol, CT 06010-3049 | 2015-04-23 |
| 1457783490 | Amber Lynn Schreiner | Pharmacist | 1 Prince Ln, Bristol, VT 05443-1224 | 2013-08-01 |
| 1306282884 | Penni Anne Cheatle | Pharmacist | 160 Indiana St, Bristol, CT 06010-9138 | 2013-05-10 |
| 1932451473 | Katrina A Yoder | Pharmacist | 300 E Elkhart St, Bristol, IN 46507-9205 | 2012-10-08 |
| Find all providers in BRISTOL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.