Provider Demographics
NPI:1790595403
Name:STEPHENS, TANNER JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:JOHN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 SE 9TH CIR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-0709
Mailing Address - Country:US
Mailing Address - Phone:405-625-9369
Mailing Address - Fax:
Practice Address - Street 1:3651 W ROBINSON ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3628
Practice Address - Country:US
Practice Address - Phone:405-360-5406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist