Provider Demographics
NPI:1437231016
Name:TANNER, HEIDI RENEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:RENEE
Last Name:TANNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:R
Other - Last Name:VINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 N DIXON RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4131
Mailing Address - Country:US
Mailing Address - Phone:765-452-9000
Mailing Address - Fax:765-452-9633
Practice Address - Street 1:201 N DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4097
Practice Address - Country:US
Practice Address - Phone:765-457-1191
Practice Address - Fax:765-868-3184
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020973A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist