Provider Demographics
NPI:1447501788
Name:SAGE, TARA MICHELLE (RPH)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:SAGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 SW MISSION WOODS DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5604
Mailing Address - Country:US
Mailing Address - Phone:785-228-9700
Mailing Address - Fax:785-228-1375
Practice Address - Street 1:2860 SW MISSION WOODS DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5604
Practice Address - Country:US
Practice Address - Phone:785-228-9700
Practice Address - Fax:785-228-1375
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist