Tara Boulos Roeckner, PHARM. D.
Individual provider Active NPI Pharmacist · Valrico, FL
NPI 1083290761 · NPPES record last updated Mar 22, 2021
Key facts
- NPI
- 1083290761
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 60685 (FL)
- Practice address
- 2109 E State Road 60
Valrico, FL 33594-3702 - Phone
- (813) 684-0583
- NPI assigned
- Mar 22, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60685 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holiday CVS LLC | Past |
Accepting new patients | |
| Holiday CVS L.L.C. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 60685 | FL | Yes |
Addresses
Primary practice location
2109 E State Road 60
Valrico, FL 33594-3702
Mailing address
9210 Estate Cove Cir
Riverview, FL 33578-3103
Phone (561) 213-3569
Other providers in Valrico, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.