Provider Demographics
NPI:1902401110
Name:DODD, TANNER DOW (RPH)
Entity Type:Individual
Prefix:DR
First Name:TANNER
Middle Name:DOW
Last Name:DODD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 PENDLETON DR APT 2208
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2684
Mailing Address - Country:US
Mailing Address - Phone:254-228-6535
Mailing Address - Fax:
Practice Address - Street 1:1110 EARL RUDDER FWY S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2626
Practice Address - Country:US
Practice Address - Phone:979-207-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist