TARA K JELLISON (NPI# 1871082412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871082412 |
| Entity Type | Individual |
| Full Name | TARA K JELLISON |
| Credential | PHARMD |
| Practice Address |
11109 Parkview Plaza Drive -- Attn Pharmacy Fort Wayne IN 46845 |
| Practice Telephone | 2602664404 |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2018-05-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 26019460A | IN | Pharmacy Service Providers |
| Street Address |
11109 PARKVIEW PLAZA DRIVE -- ATTN PHARMACY |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46845 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881154110 | Nancy Jean Ehmke | Clinical Nurse Specialist | 11151 Parkview Plaza Dr, Fort Wayne, IN 46845 | 2019-03-22 |
| 1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
| 1578097572 | Forefront Dermatology, S.c. | Dermatology | 4020 New Vision Drive, Fort Wayne, IN 46845 | 2017-04-17 |
| 1811437999 | Jessica Ann Lefever | Behavioral Analyst | 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 | 2017-03-08 |
| 1033668041 | Bhi Home Care, Inc. | In Home Supportive Care | 820 Mill Lake Road, Fort Wayne, IN 46845 | 2016-10-03 |
| 1467814939 | Austin Wyss | Specialist/Technologist | 11130 Parkview Circle Drive, Ft. Wayne, IN 46845 | 2016-03-24 |
| 1154713584 | Ashley Whitcraft | Specialist/Technologist | 11130 Parkview Plaza Drive #4, Fort Wayne, IN 46845 | 2015-02-23 |
| 1275975682 | Lakshmi Mohan Viji Das | Internal Medicine | 11143 Parkview Plaza Dr Ste 311, Fort Wayne, IN 46845 | 2013-07-26 |
| 1336482496 | Mithun Mohana Shenoi | Colon & Rectal Surgery | 11104 Parkview Circle Drive Suite 320, Fort Wayne, IN 46845 | 2013-03-27 |
| 1962744979 | Daniel Jerome | Physical Therapist | 11104 Parkview Circle Drive., Fort Wayne, IN 46845 | 2013-03-18 |
| Find all providers in zip 46845 | ||||
| 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 |
|---|---|---|---|---|
| 1295347102 | Austin Hartzog | Pharmacist | 5110 Value Drive, Fort Wayne, IN 46808 | 2020-08-21 |
| 1528677622 | Leslie Renee Siegel | Pharmacist | 11109 Parkview Plaza Dr # 1, Fort Wayne, IN 46845-1701 | 2020-07-24 |
| 1962048140 | Andrew Quang Tran | Pharmacist | 6202 Saint Joe Center Rd, Fort Wayne, IN 46835-2506 | 2019-11-21 |
| 1467005991 | Nicholas Selby | Pharmacist | 6220 Saint Joe Center Rd, Fort Wayne, IN 46835-2506 | 2019-07-23 |
| 1215427042 | Jerry Eugene Falls | Pharmacist | 9817 Chapmans Blvd, Fort Wayne, IN 46835-9194 | 2018-05-17 |
| 1063900611 | Juliette Peters | Pharmacist | 1900 Carew St Ste 4, Fort Wayne, IN 46805-4765 | 2018-04-30 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1790238350 | Karleen Goodwin | Pharmacist | 3964 New Vision Dr, Fort Wayne, IN 46845-1712 | 2016-08-01 |
| 1699131300 | Brent Alan Losier | Pharmacist | 3537 N Anthony Blvd, Suite A, Fort Wayne, IN 46805-1423 | 2016-01-11 |
| 1902273444 | Brian Bates | Pharmacist | 5005 Iris Ave, Apt 421, Fort Wayne, IN 46825-2772 | 2015-09-01 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46845 |
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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.