Healthcare Provider Details

I. General information

NPI: 1578089363
Provider Name (Legal Business Name): TANNER RATHBONE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N STATE ST
CONCORD NH
03301-5015
US

IV. Provider business mailing address

165 N STATE ST
CONCORD NH
03301-5015
US

V. Phone/Fax

Practice location:
  • Phone: 603-223-6713
  • Fax:
Mailing address:
  • Phone: 603-223-6713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-04305
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: