Individual
TANNER ALAN TIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
911 S AIR DEPOT BLVD, MIDWEST CITY, OK 73110-4836
(405) 737-3464
(405) 737-9554
Mailing address
911 S AIR DEPOT BLVD, MIDWEST CITY, OK 73110-4836
(405) 737-3464
(405) 737-9554
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17544
OK
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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