Individual
DAVID J TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
200 W MAIN ST, JACKSON, TN 38301-6114
(731) 427-1528
(731) 423-4590
Mailing address
202 RIDGE RD, MEDINA, TN 38355-7606
(731) 783-3036
(731) 423-4590
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3629
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3534364
—
TN
01
—
4406977
N.C.P.D.P.
TN
Enumeration date
01/16/2007
Last updated
07/08/2007
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