MEDICARE: DR. TANNER WAYNE SIMON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PD13633	AR

General Provider Information

NPI Number	:	1205436441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANNER WAYNE SIMON PHARMD

Provider Business Mailing Address
First Line	:	5707 RED LEAF
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-7050
Country	:	US
Telephone Number	:	940-368-7185
Fax Number	:

Provider Business Practice Location Address
First Line	:	1368 HIGDON FERRY RD
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6411
Country	:	US
Telephone Number	:	501-625-7212
Fax Number	:	501-625-7213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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