Provider Demographics
NPI:1407728900
Name:HOLMES, TANNER QUENTIN
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:QUENTIN
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 SAVALLA BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-8844
Mailing Address - Country:US
Mailing Address - Phone:585-953-4157
Mailing Address - Fax:
Practice Address - Street 1:650 HYLAN DRIVE
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467
Practice Address - Country:US
Practice Address - Phone:585-424-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist