Provider Demographics
NPI:1639712292
Name:WOODROW, TANNER C (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:C
Last Name:WOODROW
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 1:8030 S VISCOUNTI CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6317
Mailing Address - Country:US
Mailing Address - Phone:803-200-4774
Mailing Address - Fax:
Practice Address - Street 1:655 W 5300 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5671
Practice Address - Country:US
Practice Address - Phone:801-269-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8784218-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist