Provider Demographics
NPI:1962460378
Name:GARDENER, TAWNYA RENE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:TAWNYA
Middle Name:RENE
Last Name:GARDENER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:IA
Mailing Address - Zip Code:52208-1709
Mailing Address - Country:US
Mailing Address - Phone:319-444-2480
Mailing Address - Fax:319-444-3987
Practice Address - Street 1:810 12TH ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:IA
Practice Address - Zip Code:52208-1709
Practice Address - Country:US
Practice Address - Phone:319-444-2480
Practice Address - Fax:319-444-3987
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist