Healthcare Provider Details

I. General information

NPI: 1699630137
Provider Name (Legal Business Name): TANNER CLEMENTS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 MARTIN LUTHER KING BLVD
MALVERN AR
72104-2006
US

IV. Provider business mailing address

1606 MARTIN LUTHER KING BLVD
MALVERN AR
72104-2006
US

V. Phone/Fax

Practice location:
  • Phone: 501-229-1446
  • Fax: 501-229-1397
Mailing address:
  • Phone: 501-229-1446
  • Fax: 501-229-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17434
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: