Provider Demographics
NPI:1205114493
Name:TANNER, CARLA RUTH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:RUTH
Last Name:TANNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CARLA
Other - Middle Name:RUTH
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8709 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4237
Mailing Address - Country:US
Mailing Address - Phone:817-642-0062
Mailing Address - Fax:972-572-2428
Practice Address - Street 1:7586 MOUNTAIN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75249-1356
Practice Address - Country:US
Practice Address - Phone:972-572-2423
Practice Address - Fax:972-572-2428
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist