Provider Demographics
NPI:1558562918
Name:TANNER, CHANDACE B (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHANDACE
Middle Name:B
Last Name:TANNER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:JOHNSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29555-0563
Mailing Address - Country:US
Mailing Address - Phone:843-386-9080
Mailing Address - Fax:
Practice Address - Street 1:538 MYRTLE WOOD LN
Practice Address - Street 2:
Practice Address - City:JOHNSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29555-6602
Practice Address - Country:US
Practice Address - Phone:843-386-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist