MEDICARE: TANNER REECE ABBOTT

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
1	183500000X	Pharmacist	68810	FL

General Provider Information

NPI Number	:	1497547905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER REECE ABBOTT

Provider Business Mailing Address
First Line	:	1061 S 2ND ST
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-4909
Country	:	US
Telephone Number	:	850-401-8680
Fax Number	:	850-892-6898

Provider Business Practice Location Address
First Line	:	1337 US HIGHWAY 90 W
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-1470
Country	:	US
Telephone Number	:	850-892-6898
Fax Number	:	850-892-6898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

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Directions to “ TANNER REECE ABBOTT ” Practice Location

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