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NPI Code Detail

MEDICARE: TANA STEWART

MEDICARE: TANA STEWART
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist20568CO

General Provider Information

NPI Number : 1457753535
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANA STEWART
Provider Business Mailing Address
First Line : 7536 MOUNTAIN SPRUCE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80927-4005
Country : US
Telephone Number : 712-540-9277
Fax Number :
Provider Business Practice Location Address
First Line : 5550 E WOODMEN RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-5257
Country : US
Telephone Number : 719-531-6833
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2014
Last Update Date : 07/23/2019

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Directions to “ TANA STEWART ” Practice Location

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