Provider Demographics
NPI:1407845431
Name:MOUNTS, TANYA SUE (RPH)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SUE
Last Name:MOUNTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 COUNTY ROAD 1802
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9387
Mailing Address - Country:US
Mailing Address - Phone:419-368-0050
Mailing Address - Fax:419-289-2831
Practice Address - Street 1:1025 CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4011
Practice Address - Country:US
Practice Address - Phone:419-289-0491
Practice Address - Fax:419-289-2831
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-18818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist