Provider Demographics
NPI:1417250572
Name:HIGGINBOTHAM, TANNER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TANNER
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE UNIVERSITY OF MONTANA DEPT OF PHARMACY
Mailing Address - Street 2:32 CAMPUS DRIVE #1522
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-0001
Mailing Address - Country:US
Mailing Address - Phone:406-243-4056
Mailing Address - Fax:
Practice Address - Street 1:THE UNIVERSITY OF MONTANA DEPT OF PHARMACY
Practice Address - Street 2:32 CAMPUS DRIVE #1522
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0001
Practice Address - Country:US
Practice Address - Phone:406-243-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist