Provider Demographics
NPI:1659658573
Name:BURT, TANYA CHERONDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:CHERONDA
Last Name:BURT
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 1:1130 S BELLEVUE BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-2331
Mailing Address - Country:US
Mailing Address - Phone:901-946-3676
Mailing Address - Fax:
Practice Address - Street 1:1130 S BELLEVUE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-2331
Practice Address - Country:US
Practice Address - Phone:901-946-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-06
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist