Healthcare Provider Details

I. General information

NPI: 1124627401
Provider Name (Legal Business Name): MARLEY JOSEPH TANNER PHARM,D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL WAY
CROW AGENCY MT
59022
US

IV. Provider business mailing address

PO BOX 9
CROW AGENCY MT
59022-0009
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3578
  • Fax: 406-638-3326
Mailing address:
  • Phone: 406-638-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP8966
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-71393
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: