Healthcare Provider Details

I. General information

NPI: 1558562918
Provider Name (Legal Business Name): CHANDACE B TANNER PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 MYRTLE WOOD LN
JOHNSONVILLE SC
29555-6602
US

IV. Provider business mailing address

PO BOX 563
JOHNSONVILLE SC
29555-0563
US

V. Phone/Fax

Practice location:
  • Phone: 843-386-9080
  • Fax:
Mailing address:
  • Phone: 843-386-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010298
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: