Provider Demographics
NPI:1356617880
Name:GANTT, TONYA LYNN
Entity type:Individual
Prefix:DR
First Name:TONYA
Middle Name:LYNN
Last Name:GANTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SIR GREGORY DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-7718
Mailing Address - Country:US
Mailing Address - Phone:704-434-8759
Mailing Address - Fax:704-434-8759
Practice Address - Street 1:105 EAST COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28017
Practice Address - Country:US
Practice Address - Phone:704-434-6560
Practice Address - Fax:704-434-5389
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist