Healthcare Provider Details

I. General information

NPI: 1437231016
Provider Name (Legal Business Name): HEIDI RENEE TANNER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI R VINT

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N DIXON RD
KOKOMO IN
46901-4097
US

IV. Provider business mailing address

207 N DIXON RD
KOKOMO IN
46901-4131
US

V. Phone/Fax

Practice location:
  • Phone: 765-457-1191
  • Fax: 765-868-3184
Mailing address:
  • Phone: 765-452-9000
  • Fax: 765-452-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020973A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: