Provider Demographics
NPI:1124627401
Name:TANNER, MARLEY JOSEPH (PHARM,D)
Entity type:Individual
Prefix:DR
First Name:MARLEY
Middle Name:JOSEPH
Last Name:TANNER
Suffix:
Gender:M
Credentials:PHARM,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022-0009
Mailing Address - Country:US
Mailing Address - Phone:406-638-3578
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3578
Practice Address - Fax:406-638-3326
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8966183500000X
MTPHA-PHA-LIC-71393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist