Tiasara Mack, PHARMD

Primary specialty

Geriatric PharmacistTaxonomy code 1835G0303X

License

0202215182 Issued in VA

Practice address

1832 Kempsville Rd
Virginia Beach, VA 23464-6861

Phone

(757) 278-2573

NPI assigned

Nov 10, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wal-Mart Stores East LP

  dba WalMart Pharmacy 10-6226

  • Community/Retail Pharmacy
  • Virginia Beach, VA
  • NPI 1487061453
  NPD (past)
• Wal-Mart Stores East, LP

  dba Walmart Pharmacy 10-2229

  • Pharmacy
  • Apollo Beach, FL
  • NPI 1437027208
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1699377135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1872 SOMERTON PL",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234646944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1832 KEMPSVILLE RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234646861",
            "telephone_number": "757-278-2573"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1872 Somerton Pl",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234646944",
            "country_code": "US",
            "telephone_number": "757-372-1682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "TIASARA",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-10",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "VA",
            "license": "0202215182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA BOARD OF PHARMACY LICENSE NUMBER",
            "identifier": "0202215182",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tarties.s06226.us@wal-mart.com",
            "affiliation": "Y",
            "affiliationName": "Wal-Mart Stores East LP",
            "address_1": "1832 Kempsville Rd",
            "address_2": "Suite 100",
            "city": "Virginia Beach",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234646861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bethany Joy Macintosh, DMD
• Amy K Mack, NP
• Bryan Mack
• Hershel Mack, PA-C, ATC
• Lawanna Anean' Mack
• Tiffany Michelle Mack, M.S., CCC-SLP
• Tre'Necia Mack
• Elizabeth Marie Mackey
• Gillian Mackey, PT, DPT
• Andrea Marie Mackie, OT

• Geriatric Pharmacist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Geriatric Pharmacist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.