Provider Demographics
NPI:1912350075
Name:TANNER, CHRISTOPHER A (PHARMD RPH)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:TANNER
Suffix:
Gender:M
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1027
Mailing Address - Country:US
Mailing Address - Phone:860-633-4186
Mailing Address - Fax:860-633-4518
Practice Address - Street 1:2900 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1027
Practice Address - Country:US
Practice Address - Phone:860-633-4186
Practice Address - Fax:860-633-4518
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT. 0013741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT. 0013741OtherCT PHARMACIST REGISTRATION