Provider Demographics
NPI:1437551058
Name:TANNER, EUGENIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6042 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-3402
Mailing Address - Country:US
Mailing Address - Phone:317-453-0917
Mailing Address - Fax:
Practice Address - Street 1:6042 E 43RD ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-3402
Practice Address - Country:US
Practice Address - Phone:317-453-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024195A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist