Provider Demographics
NPI:1073620407
Name:TANNER, BEVERLY H (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BEVERLY
Middle Name:H
Last Name:TANNER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 RAILROAD AVE E
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-1247
Mailing Address - Country:US
Mailing Address - Phone:912-529-6693
Mailing Address - Fax:
Practice Address - Street 1:132 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6116
Practice Address - Country:US
Practice Address - Phone:478-272-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist