Provider Demographics
NPI:1225508625
Name:VOLZ, TANNER REID
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:REID
Last Name:VOLZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 SE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2334
Mailing Address - Country:US
Mailing Address - Phone:918-876-4204
Mailing Address - Fax:918-876-4206
Practice Address - Street 1:143 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2334
Practice Address - Country:US
Practice Address - Phone:918-876-4204
Practice Address - Fax:918-876-4206
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist