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General NPI Number Information
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NPI Number | 1407446776
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Entity Type | Individual
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Provider Name | TANNER AUSTIN TRANTHAM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 3800 GATEWAY CENTRE BLVD STE 308-A
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City | MORRISVILLE
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State | NC
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Zip | 27560-6220
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Country | US
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Telephone | 919-586-8287
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Fax |
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Provider Business Mailing Address
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Address Line | 4814 HOPEWOOD CT
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City | GRAHAM
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State | NC
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Zip | 27253-8177
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Country | US
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Telephone | 336-520-3227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 29823
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License Number State | NC
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