Tara Lee Costa-Wallace, PHARMD
NPI 1629224456ActiveIndividual· Pharmacist· Bristol, RI
Pharmacist (PHARMD) in Bristol, Rhode Island, licensed in RI, with an NPI issued in August 2008.
Overview
| NPI | 1629224456 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHARMD |
| Sole proprietor | No |
| NPI issued | Aug 12, 2008 |
| Last updated in NPPES | Aug 12, 2008 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacist Primary | 183500000X | RPH03692 | RI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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