Provider Demographics
NPI:1073746756
Name:GRUNTMEIR, TANYA MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:MARIE
Last Name:GRUNTMEIR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:FELTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57226-0247
Mailing Address - Country:US
Mailing Address - Phone:605-874-8220
Mailing Address - Fax:
Practice Address - Street 1:411 THIRD AVE SOUTH
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:SD
Practice Address - Zip Code:57226-0247
Practice Address - Country:US
Practice Address - Phone:605-874-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist