Healthcare Provider Details

I. General information

NPI: 1962460378
Provider Name (Legal Business Name): TAWNYA RENE GARDENER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 12TH ST
BELLE PLAINE IA
52208-1709
US

IV. Provider business mailing address

810 12TH ST
BELLE PLAINE IA
52208-1709
US

V. Phone/Fax

Practice location:
  • Phone: 319-444-2480
  • Fax: 319-444-3987
Mailing address:
  • Phone: 319-444-2480
  • Fax: 319-444-3987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17207
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: