Provider Demographics
NPI:1497369755
Name:ISENHART, TANYA LOUISE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LOUISE
Last Name:ISENHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-7849
Mailing Address - Country:US
Mailing Address - Phone:304-364-5161
Mailing Address - Fax:304-364-8951
Practice Address - Street 1:2907 STATE ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-7849
Practice Address - Country:US
Practice Address - Phone:304-364-5161
Practice Address - Fax:304-364-8951
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0006079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist