Healthcare Provider Details

I. General information

NPI: 1689578965
Provider Name (Legal Business Name): DR. TANNER ORFANIDES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 39TH ST
PHILADELPHIA PA
19104-2640
US

IV. Provider business mailing address

3862 LANCASTER AVE APT 205
PHILADELPHIA PA
19104-2170
US

V. Phone/Fax

Practice location:
  • Phone: 607-368-8438
  • Fax:
Mailing address:
  • Phone: 607-368-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP460357
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: